Hooked on drug ads, education collision in Hawaii, and the gas frenzy

By Steven Brill
March 27, 2012

1. Are Diane Sawyer, Scott Pelley and Brian Williams hooked on Cymbalta?

Every time I suffer through the (simultaneously timed) commercial breaks on one of the network evening news shows I wish I could read a story about prescription drug advertising on television. I’ll bet these ads now account for two-thirds or more of revenues for the network news shows, whose viewer demographics are apparently perfect targets for drugs directed at older people with erectile dysfunction, withering bones, dry eyes, insomnia, lung malfunction (as illustrated by an elephant sitting on some guy’s chest), incontinence, and whatever it is that is cured by something called Cymbalta, whose ads I think I saw on all three shows the other night.

To what extent does the federal government’s decision to allow, beginning in the mid-1990s, such direct-to-consumer ads keep these once-revered nightly news shows afloat? (A sidebar should also cover how these ads boost the economics of struggling magazines, in large part because the rules require a page of small print detail about dosage and side effects following the glitzy image ad.) At a time when healthcare costs are a national crisis, does the American policy of allowing these ads, which most countries prohibit, create unnecessary demand and needless expense? Or do they give patients important information? Does telling me I might have a disease that I had never heard of help me address a malady before it gets worse, or does it make me a prescription-guzzling hypochondriac? How does the Food and Drug Administration, which regulates such advertising, evaluate all that, and what kind of lobbying do the networks and drug companies do to influence that debate? Or is there no longer a debate?

And what are the rules governing the hilarious recitations of possible side effects? How fast is the announcer allowed to breeze through describing the risk of suicide, hives, sleepwalking, backache, swelling of the tongue, depression, migraines, miscarriage or four-day (or is it four-hour?) erections?

2. Will the U.S. education secretary help determine control of the Senate?

There’s a showdown looming this fall over President Obama’s most highly touted domestic policy initiative, and it could end up deciding a Senate race in Hawaii – and perhaps even control of the Senate.

Some pundits scoping out the 2012 Senate races have started to look at Hawaii, where the retirement of three-term Democrat Daniel Akaka has created an open seat. Former two-term Republican Governor Linda Lingle is likely to win her primary in August and face either Democratic congresswoman Mazie Hirono or former Democratic congressman Ed Case, who are competing in their party’s primary. Current polls suggest that Lingle, who was more popular than Neil Abercrombie, the Democrat who has replaced her, has at least a fighting chance to buck Hawaii’s tradition as a Democratic stronghold and become only the second Republican senator Hawaii has ever elected.

But there’s an extra angle to the Hawaii race that someone ought to look at: In the summer of 2010, Hawaii was one of 11 states (along with the District of Columbia) chosen as a winner of President Obama’s Race to the Top education grant program. The winners were meant to be those states that presented the best plans to reform their K-12 education systems by enacting the kinds of teacher evaluation and accountability programs that teachers’ unions – which are the base of the Democratic Party – have traditionally opposed. Despite the unions’ opposition, President Obama pushed Race to the Top through Congress. Still more surprising to the pols, policy wonks and lobbyists who follow education in Washington, the Obama administration then wrote regulations that gave the program real teeth.

The outside experts chosen to vet each state’s reform proposals were instructed to award points according to painstakingly specific criteria, and they were charged with doing so based not only on what each state promised but also on how likely it was that the state could and would actually deliver.

The problem, as I reported in a book (Class Warfare: Inside the Fight to Fix America’s Schools) published last summer, was that to avoid charges of conflicts or favoritism, Education Secretary Arne Duncan and his staff chose a group of mostly academic vetters, rather than experts experienced in education reform, to evaluate the states’ 500-to-800-page proposals. This may have made the process above reproach, but it also resulted in having many vetters who were clueless about the practical issues involved in implementing reform.

Thus, some of the evaluators’ winning picks, such as New York and Ohio, and some of their rejections, particularly Colorado and Louisiana, were hotly debated in education circles, with critics arguing that these were emblematic misfires in an evaluation process in which the vetters had been bamboozled by the applicants’ promises of reform. But the $75 million award to Hawaii – where the teachers’ union is the state’s most powerful Democratic interest group and where the state’s promises in its application had been filled with gaping loopholes – wasn’t really debated at all. No one outside of Hawaii tried to defend it. It was broadly dismissed as a fiasco. In fact, Duncan and his staff couldn’t believe it when they saw Hawaii on the winners list.

However, when I asked Duncan just after Hawaii got the nod what he would do if states failed to keep their promises, he vowed he would cut off the money, which is to be awarded in eight increments over four years – or even sue to get money back where checks had already been written.

Twenty months later, the Hawaii state teachers’ union has refused to agree to the evaluation and accountability reforms that were the core of the state’s winning application. And so far, Hawaii has requested 31 amendments to its application, all involving delays in its promised schedule or a watering down of its promises. Duncan’s office has approved 27 of them, but he has reiterated his vow to hold Hawaii accountable. He has even formally placed Hawaii on “high risk” status, meaning he might revoke its funding if he doesn’t see progress soon.

Crunch time on fulfilling many of the Race to the Top promises should be early this fall. That will mark the second anniversary of the original award and would supposedly mark the half-way point in the four-year program. Yet it’s likely that Hawaii will have done little, if anything, even to begin implementing the key reforms it promised.

Duncan has been a straight arrow when it comes to keeping politics out of the Race to the Top contest. Then again, the $75 million Hawaii grant is lot of money for a state this small, and the failure of Governor Abercrombie to deliver on his state’s reform promises has gotten a fair amount of local press. So, if there’s a tight Senate race in Hawaii this fall that might even determine control of the U.S. Senate, will Duncan stick to his guns and undercut the Democratic candidate, not to mention embarrass the Democratic governor, by lowering the boom?

3. Who’s getting what at the oil pump?

With all the frenzy over oil prices, I’d like to see a simple but definitive story that takes a gallon of the gasoline Americans buy and breaks down exactly who gets how much of the $4.00 (or whatever the price is), starting with owners of the oil fields and including drillers, shippers, refiners, distributors, retailers, and, of course, the tax collectors. And which of these parties benefits the most when the price goes up?

PHOTO: U.S. President Barack Obama delivers remarks next to Secretary of Education Arne Duncan about providing states flexibility under No Child Left Behind in exchange for reform at the White House in Washington February 9, 2012. REUTERS/Yuri Gripas

22 comments

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I’d like to see these stories too, particularly #1 and #3. You’re the journalist, right?

Posted by Nullcorp | Report as abusive

“does the American policy of allowing these ads, which most countries prohibit, create unnecessary demand and needless expense? Or do they give patients important information?”

I am a media strategist working on the account of a major pharma client. Creating demand is always the goal–whether or not it’s “unnecessary” demand or “needless” expense depends on the drug. Many campaigns, especially those for new drugs which treat serious disease states, are intended to be informational and spread awareness. This isn’t as altruistic as it sounds, though, because if our client, for example, has a patent on the only drug which treats the disease, spreading awareness necessarily drives sales–this is why we still spend a lot of money on non-branded campaigns in Europe and other places where branded pharma ads are illegal.

As for “me-too” drugs, in my opinion the demand created is largely unnecessary, but that’s because the drugs themselves, for most people, are unnecessary. Should we be allowed to advertise them? Well, there are all kinds of products advertised which people don’t “need” but make their lives easier. There is still value there.

In all cases, though, efficacy claims have to be supported by a great deal of disclosures which go along with the ad. This usually means, for example, we have to buy 2 pages instead of one. Just from my experience dealing with print and TV vendors I know that we are a major factor in their sales forecasting, but I couldn’t say whether or not their livelihood depends on pharma ads.

Posted by Snake.Plissken | Report as abusive

In the early half of the 20th century, petrochemical giants organized a coup on the medical research facilities, hospitals and universities. The Rockefeller family sponsored research and donated sums to universities and medical schools which had drug based research. They further extended this policy to foreign universities and medical schools where research was drug based through their “International Education Board”. Establishments and research which were were not drug based were refused funding and soon dissolved in favor of the lucrative pharmaceutical industry. In 1939 a “Drug Trust” alliance was formed by the Rockefeller empire and the German chemical company I.G. Farben (Bayer). After World War II, I.G. Farben was dismantled but later emerged as separate corporations within the alliance. Well known companies included General Mills, Kellogg, Nestle, Bristol-Myers Squibb, Procter and Gamble, Roche and Hoechst (Sanofi-Aventis). The Rockefeller empire, in tandem with Chase Manhattan Bank (now JP Morgan Chase), owns over half of the pharmaceutical interests in the United States. It is the largest drug manufacturing combine in the world. Since WWII, the pharmaceutical industry has steadily netted increasing profits to become the world’s second largest manufacturing industry; [3], [4] after the arms industry.
The Rockefeller Foundation was originally set up in 1904 as the General Education Fund. The RF was later formed in 1910 and issued a charter on May 14, 1913 with the help of Rockefeller millions. Subsequently, the foundation placed it’s own “nominees” in federal health agencies and set the stage for the “reeducation” of the public. A compilation of magazine advertising reveals that as far back as 1948, larger American drug companies spent a total sum of $1,104,224,374 for advertising. Of this sum, Rockefeller-Morgan interests (which went entirely to Rockefeller after Morgan’s death) controlled about 80%. [5] See also AMA.
IG Farben & Auschwitz
Auschwitz was the largest mass extermination factory in human history. However, few people are aware that Auschwitz was a 100% subsidiary of IG Farben. On April 14, 1941, in Ludwigshafen, Otto Armbrust, the IG Farben board member responsible for the Auschwitz project, stated to board colleagues:
“our new friendship with the SS is a blessing. We have determined all measures integrating the concentration camps to benefit our company.”
Thousands of prisoners died during human experiments, drug and vaccine testing. Before longtime Bayer employee and SS Auschwitz doctor Helmut Vetter was executed for administering fatal infections, he wrote to his bosses at Bayer headquarters:
“I have thrown myself into my work wholeheartedly. Especially as I have the opportunity to test our new preparations. I feel like I am in paradise.”
After WWII, IG Farben attempted to shake its abominable image through corporate restructuring and renaming. So great has been their success that the public has no idea that it many of the men responsible for such atrocities, were able to carry on their work even after the collapse of the Nazi regime. Namely a medical paradigm that relies almost exclusively highly toxic drugs. Such men were in control of the large chemical and pharmaceutical companies, both well before and after Hitler. The Nuremberg Tribunal convicted 24 IG Farben board members and executives on the basis of mass murder, slavery and other crimes. Incredibly, most of them had been released by 1951 and continued to consult with German corporations. The Nuremberg Tribunal dissolved IG Farben into Bayer, Hoechst, and BASF, each company 20 times as large as IG Farben in 1944. For almost three decades after WWII, BASF, Bayer and Hoechst (Aventis) filled their highest position, chairman of the board, with former members of the Nazi regime. Bayer has been sued by survivors of medical experiments such as Eva Kor who, along with her sister, survived experiments at the hands of Dr. Josef Mengele.
Drug companies have new top salesmen: doctors. According to a mid-July 2005 report by the Wall Street Journal, hiring a doctor to speak about drug therapies to other doctors has proven to be a “highly effective” way for the pharmaceutical industry to market its drugs.
“An internal study done by Merck & Co. several years ago calculated the “return on investment” from doctor-led discussion groups was almost double the return on meetings led by the company’s own sales force. According to the document, doctors who attended a lecture by another doctor wrote an additional $623.55 worth of prescriptions for the painkiller Vioxx over a 12-month period compared with doctors who didn’t attend. Doctors who participated in the more intimate discussions wrote an additional $717.53 worth of prescriptions for Vioxx, which Merck pulled from the market last year over concerns about cardiovascular side effects. That compared to an increase of only $165.87 in Vioxx prescriptions by doctors who attended a meeting with a salesperson.”
In 1996, researcher Sheldon Krimsky of Tufts University studied nearly 800 scientific papers in prominent biology and medical journals. In one third of all cases, the author had financial interests in the company sponsoring the research. This information was not disclosed to readers in most cases. In a 1996 Stanford University study by Mildred Cho, a senior research scholar at the Center for Biomedical Ethics; found that 98% of university studies funded by drug companies reported new therapies to be more effective than standard ones. By comparison, only 79% of non-industry financed studies found new drugs to be more effective

Posted by Thomasmkelly | Report as abusive

Thomasmkelly: Wow- amazing writeup. I have read bits and pieces of how drug companies were involved in the death camps in WW2, and what you wrote puts quite a historical perspective on this. Nice job. I think the constant bombardment of statins- Creston, etc, against the ‘evil cholestrol menace’, is another interesting drug company ‘education effort’ if you will. A good read is ‘The Great Cholestrol Con’. Whether you agree with it or not, it offers some interesting insight into how the major pharmaceuticals work.

Posted by 2enduro | Report as abusive

Thank you Thomas for the well researched information. I didn’t know about the link between Bayer and the Holocaust.

Posted by billionstars55 | Report as abusive

I have shared Mr. Kelly’s comment and this article with others. This is good information to share that helps illustrate the control that large corporations have in our lives.

I am a provider of non-drug health care, in an educated, licensed profession that is almost as old as the drug industry, but is still suppressed by big pharma and organized medicine. I try to have the many drug ads torn out of the magazines that are placed in my reception room.

Making a fair profit is a good thing, but the drug industry is much more about profit and money than it is about health. There is so much more to this story.

Posted by taxcorps2 | Report as abusive

Re: #3. Here’s a simple (too simple?) breakdown of gas prices. http://www.youtube.com/watch?v=1YYy0DEOp oU

Posted by AndyJoe | Report as abusive

Yo Thomas, well said!
The history is there, and is growing.
If you focus only on financial incentives, you get a rather pathetic view of greed, graft and corruption at the expense of today’s end user-patient.
Take it one step further:
Digging deeper, you find the outward appearance of “curing chronic conditions”. Some doctors reported back in the 70′s, 80′s and 90′s that only 10% of all pharmaceutical drugs work long-term! Most either mask symptoms or give even worse symptoms. So Americans have the most expensive health care system on earth, with most people suffering from chronic disease being put on drugs for life, or “cut, burned or radiated”. No wonder life average American expectancy is getting shorter. A breast cancer survivor is considered cured if they live 5 years after treatment! Who wrote these definitions? What basis of judgement was used?
Only major medical emergencies are handled well these days. And for that we need the specialists and surgeons.
By brain washing the average tv watching American and buying the loyalty of higher research institutions, little true, independent science comes out of the US. Nevermind, those little bits of toxins and even radioactive iodine (standard treatment for certain thyroid conditions) now being taken by over 50% of all Americans are ending up in our water supplies nationwide.
Americans are paying an ever inflated price for drug treatments that are actually best handled through nutrition, not toxins.
Medical schools do not teach nutrition to doctors, or some get a total of 4 hours of classes during their entire training.
The irony here is the entire drug care system, insurance reimbursement and medical training is drug toxin-based, and does not treat the majority of issues being presented these days, chronic diseases like obesity, diabetes, heart disease and arthritis, very well at all! The demand for hip an knee replacements are slated to explode in the next 10 years. One answer is in earlier and better preventative health and nutrition education. Drugs are too little, too late. They amount to high cost short lived “solutions” for many.

My question is how to take off the veil of this high priced and way under-performing lunacy?

Posted by shorebird | Report as abusive

As a former resident I got a kick out of the story on Hawaii. Back in the 80s, ‘third world’ was not too strong of a term for the political and economic structure there, and the public education system was a joke despite having a fair share of gifted and committed individual educators. You have to admit that where there is actually serious discussion as to whether classes might be taught in pidgin, something is wrong. Just about anybody who could afford to do so, put their kids into one of a number of private schools over there (we could not; we left the state).

Clearly, Hawaii has/had a lot of room for reform and improvement, which might have had something to do with their selection. Just as clearly, to anyone familiar with it, the public education system has too much intertia to change. The delays are just stalling techniques as they realize that nobody is going to do it.

Posted by RynoM | Report as abusive

I remember when lawyers and drugs makers couldn’t advertise. The physicians themselves still can’t advertise. They are supposed to be professionals and scientists; not hucksters. I think that is more than an attempt on their part, to preserve an image.
But attractive and pretty ads with cartoon graphics are not rational or measured presentations designed to impart useful information. They are designed to seduce the potential customer with dreams of happy ever after. The potential customer can then pressure his physician to prescribe the drugs. The seduced consumer (and all the others using any drugs – the mirror image of the argument used to justify mandatory health insurance) than pay for all that misleading advertising.

It’s one thing for the over the counter medications to be advertised because for the most part they are relatively harmless and they don’t need a prescription. The practitioners get free samples of the heavy impact drugs and why they are advertised at all to the general public is still suspicious to many like me. The advertising is designed to make those drugs the drug of choice for certain conditions.

BTW – most medications are not advertised anywhere but in the trade journals. Why so much advertising for anti- depressants and mood stabilizers in the media aimed at the general public? As I recall, The Physicians Desk Reference (I don’t have a copy) is a massive volume filled with information about both diseases and drugs. Why isn’t that sufficient to get the word out? The simple answer is that people like me probably don’t have the background or patience to read it all. I have a hard time getting through the very long clinical information I’ve seen that came with medications I was prescribed. It’s tough going for someone who’s last biology classes were in High School. Talking to people who use the drugs is useful but people usually talk like they are experts even when they have little more information than I have. To dig in and challenge to information is rude in a social interaction.

The purpose of advertising is to create a demand and they can even make a false demand and they will never stress the drawbacks of the medication. That would be very bad for the effect they try to create. The physician who disappoints a potential “customer’ may even feel compelled to prescribe what the patient wants because it is good for his practice. The patient can seek help elsewhere and get what he wants and dismiss the more careful doctor as old fashioned or uninformed. Doctors are businessmen too.

Our grandparents and parents had the more sensible and world wary attitude and the law to back it up.

There is also something cruel about creating a demand for medications and then having to confront a delivery system that is becoming too expensive for those without insurance. and all the while the advertising is making the medications more expensive and the drug companies seek trade protection against cheaper imports.

Why advertise when the medication can’t be obtained without a physician’s approval anyway?

Posted by paintcan | Report as abusive

Surprisingly silent is medical marijuana. Enormous profits for violent drug lords; and the FEDS are trying to shut down lawful state-approved medical marijuana dispensaries. Why? Patients are smart enough to grow their own medicines; thereby cutting off big pharma from profits. Our govt would rather enrich drug lords than provide low/paltry profits to pharma who might want to get involved in medical marijuana. All the arguments regarding the medical aspects of marijuana aside; it is purely the MONEY that is keeping this illegal.

Posted by SteveAREALTOR | Report as abusive

I really enjoyed Thomasmkelly’s narrative.

As a surgeon, I don’t like drug companies or their representatives, nor their subtle unethical bribes which have mostly gone away. I don’t like how they have taken over medicine. Doctors do trust other doctors because we are trained by older doctors as mentors. If I learn that there is a better medication, I will switch. There IS a loser drug. The question is whether the winner is a more expensive patented drug taking out a cheaper generic drug.

I also think that everyone should learn to grow medical cannabis for their chronic illnesses, since it is safer and more effective for many chronic diseases and terminal illness. (Drug companies and the Feds don’t like to hear that truth)

Society has a lot of high expectations, and there are no simple answers. One thing that would help greatly is for people to try and be healthier by eating correctly, not getting overweight, and being active. Another is to avoid things that are obviously harmful. I can’t make anyone do that and it can’t be legislated very easily. So many things are preventable.

Lastly, society has to learn how to accept aging, death and dying better, and not waste family money, well being and Medicare monies on doing everything possible so that someone lives a few more months. We can’t afford it.

It is hard to say no to what people expect, especially if they get mad and get a lawyer.

Posted by LaughingDr420 | Report as abusive

The drug companies run this country. It is ludicrous. This is why you can’t find affordable healthcare. Additionally, they market them to people and use them as Ginny pigs. You think you can walk-in into a doctor’s office and say give me this drug or that drug? It supposedly cures your current symptom but the side effects will kill you.
I have never seeing drug ads on international TV. And I lived all over the world. Only in this country!.

Posted by joemanjoe | Report as abusive

A whole lot of what BigPharma peddles is nothing but snake oil. It might be the 21st century, but the approval system cares little for safety or in-depth honest reporting of side-effects. A lot of the stuff is really dangerous and does at least as much (if not more) harm than good.

Eat really well. Exercise. Check out alternative and holistic remedies.

Posted by jeff81201 | Report as abusive

Advertising or the news—I don’t know which is the most obnoxious today. Have you noticed that there is very little news on the weekends? And the stars (the anchors), the news, and the holidays—not one present as a holiday approaches. In combination, it’s a “show” I have decided to skip. Somewhere along the way, the networks decided it was not about entertainment or education or reporting, but solely about profit. Address a certain demographic with what they think will sell and the saturate the time with both meaningless content and stupid, deceptive advertising. Approaching 70, I see seniors in nursing homes looking at television and feel an approaching deprivation too boring and painful to think about!

Posted by rm12 | Report as abusive

Truly a pernicious situation.

I suspect Big Pharma is behind the push to raid marijuana dispensaries.

Most troubling is the terrible burden Big Pharma places on the country’s financial resources.

If as much money was spent on saturating the media with information on healthy eating and bodily maintenance, the “need” for Big Pharma’s snake oil would dissolve like aspirin in a glass of water.

Thanks to all contributors to this intelligent debate.

Posted by therats69 | Report as abusive

Drugs are profitable for many in this country. Only difference here is that these drug dealers are ‘blessed’ by the corporate-government alliance against the people of the US.

The others get beat up and jailed by the corporate-government thugs, for infringing on the profit ‘turf’ of the pharma companies.

Which that and the drug testing industry are the only real reasons things like Pot are even illegal.

Posted by Overcast451 | Report as abusive

I have been diagnosed as having very high cholesterol for years since a med examination when I was in the USA Army, during WWII. This high cholesterol has been detected each time I have had blood tests over the years and cholesterol lowering drugs are often recommended. No, never take them.

Now, in my mid eighties, my blood pressure is normal, as some physicians have observed, “as good as would be expected in people half your age”!

This leads me to conclude that people are different. Yes, we should know this, but it’s so easy for the medical industry to place everyone in specific boxes and then solemnly conclude that we need the treatment du jour.

Posted by HeyYu | Report as abusive

It is very important for all individuals to look up medicines that are prescribed for them. I have heart (which was first dtermermined as heartburn) and back problems. I have been given wrong mediciations and medications that conflict with what I take. I found out about this by looking up the interaction checker on different medical websites devoted to drugs.

Do not trust all doctors even if they know every single medication you take. There are severe interactions between most. Even your pharmacist may not know all of the meds you are taking.

As far as the television advertisements, I usually only watch the local news and then stick to the no commercial channels or on-demand shows. I get most of my news from Reuters and MSNBC on the internet.

As far as the education bonus, I agree with the fact that the funds should be pulled or teachers replaced if the education levels are not improving. Children need to be leaning more to compete as they get older, but to me, most of the problem is with the parents. Not the schools or majority of teachers.

Concerning the gas prices, our government should just set the price here in the states for oil and gas produced here and make it economical to own a car. Electrics are way out of my reach financially plus they will not cover the distance I need to cover. Only extra oil, gas and chemicals not needed in the U.S.A. should be sold on the world market after our reserves are stocked and tanks are full. The money the government has lost on Solydra alone would probably have been enough to clean up several of the older coal burning plants that have been shut down, causing coal jobs and many other jobs to go away.

Just my 2 cents, but it seems correct to me.

Posted by Jeepgirl | Report as abusive

Oh America. Eat what you like, do what you like, smoke what you like. Don’t worry, there’s a drug to fix it later. It may turn out to have potentially harmful side effects but don’t worry about.

Have heartburn? Still want to have five cups of coffee and that cigarette? Want to eat that burrito for lunch and spicy meal for dinner too? Worry not, there’s certainly a drug for it.

Change your eating habits? Be more healthy? Exercise? That’s just crazy and way too hard.

Zero emphasis on the obvious that would reduce healthcare costs in the long run and lead to a healthier population. Why would drug companies want that when they have doctors pushing drugs like candy? Or junk food and fast food companies for that matter.

Decadence, indulgence and can I get it right away?

Posted by TheUSofA | Report as abusive

WHAT GOOD IS A PHARMACEUTICAL BUSINESS WITHOUT SICK CUSTOMERS ?
WHAT GOOD ARE ILLEGAL DRUG DEALERS WITHOUT ADDICTS ?
WHAT GOOD IS MEDIA WITHOUT MISLEADING ADS ?

Posted by GMavros | Report as abusive

All this is old news. Corporations have bought the media, the Congress, the Supreme Court and almost everything else that’s for sale and will continue to do so. Citizen’s United has declared money equivalent to speech and has declared corporations people. Citizens are only valued as consumers and their privacy has disappeared.
The United States has been “crucified on a cross of gold,” but any old metal will do……

Posted by Boguseconomist | Report as abusive