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Practice English Speaking&Listening with: September 29, 2019

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[TV static drones]

[bright tone]

[upbeat rock music]

♪ ♪

[cheers and applause]

- Welcome, welcome, welcome to "Last Week Tonight"!

I'm John Oliver.

Thank you so much for joining us.

And we have to dive straight in tonight

to the news that has been dominating this week,

and, unfortunately, I'm not talking about the fact

that Nicolas Cage will be starring in a movie

called "Pig" in which he plays a truffle hunter

who wants his pig back.

Which he is, and it's all I want to talk about.

But sadly, instead, we have to talk about this:

- Secret cover-up: the whistleblower complaint

sending shock waves through Washington.

- Troubling new details about the president's phone call

with the leader of Ukraine.

- During the call, Mr. Trump

pressured the Ukrainian president eight times

to investigate former Vice President

Joe Biden's son Hunter.

- Wow. Eight times.

The only time it makes sense

to ask for the same thing eight times in a single phone call

is if you're trying to connect with

a customer service agent for AT&T.


I got you, business daddy! I got you!

You genuinely bad company!

But look, it is true, Trump is at the center

of another looming scandal.

Basically, he's accused of withholding

nearly $400 million in military aid to Ukraine

and then using it as leverage to get dirt on Joe Biden.

It is very, very dumb.

And you might remember,

we called his Russia scandal Stupid Watergate,

which unfortunately means that we now have to work out

what the sequel should be called.

Now, we considered "Stupid Watergate II:

Look Who's Stupid Now-- The Same Guy,"

or "S2pid Watergate" with the number 2 in the word stupid

or "Stwopid Watergate"

with the word two in the word stupid.

But in the end, we settled on simply on this:

"Stupid Watergate II: the Stupidest Watergate."

And that will work fine, you know,

until the next one comes along.

Now, initially, the White House denied any wrongdoing,

even voluntarily releasing their account

of the president's call, claiming that it exonerated him,

except, when you actually read the account,

it emphatically does not do that

because Trump explicitly asks for Biden to be investigated

and follows it by saying,

"I will have Mr. Giuliani give you a call..."

And it's frankly impressive

just how thorough that abuse of power is.

He's looping in both someone so involved in the government

they should be nowhere near this kind of petty dirt

and someone so involved in petty dirt

they should be nowhere near the government.

And it got even worse the next morning

when the whistleblower's complaint was released,

which made it pretty clear that, after the phone call,

the White House worked extremely hard

to cover its tracks.

- The whistleblower says senior White House officials

worked to lock down all records

of a presidential phone call this summer

out of fear that they had witnessed the president

abuse his office for personal gain.

- It's true. The notes from the call

were stored in a separate, code word-level system

meant for highly classified information,

despite the fact there was no legitimate reason to do that.

And why do that if there wasn't something very bad in there?

If you don't want someone to see something embarrassing

on your computer, everyone knows

you just put it in a folder labeled "finance records."

I mean, I wouldn't do that,

because my finance records folder

is too full of finance records.

Wait, no, no, no, don't open it!

Don't open it-- no, no, no, no, no!

Okay, okay, okay. Here's what that is.

Here's what that is.

Yes, you have found my collection of hamsters

in little Speedos. It's not a sex thing!

I mean, that one is a bit of a sex thing.

But we don't have time.

We don't have time to get into it!

The point is, every part of this new Stupid Watergate

is dumber than you can even imagine.

Even Ukraine's president, Volodymyr Zelensky,

is himself ridiculous.

He actually used to be a comedian,

at one point playing the president of Ukraine

in a sitcom.

Although my favorite fact about him

is that one of his old comedy routines

was him and another guy

pretending to play the piano with...

well, you'll see.

[both speaking foreign language]

["Bolero" playing]

♪ ♪

- Ha!

- Yep, yeah.

He played the piano with his dick.

And just spare a thought for the guy next to him

who did that and somehow didn't get elected

president of Ukraine.

A few years later,

he's stuck playing dick-music alone on an open mic

in the basement of a Chinese restaurant.

Show business is cruel.

But even in a scandal full of absurd figures,

it is worth taking a moment

to appreciate the role played here by Rudy Giuliani,

the New York City subway of New York City mayors,

and--and a man who once fucked his cousin.

Now, is that point strictly relevant here?

No. But I would argue that,

like Giuliani and his first wife,

it is not unrelated.

Perhaps... [laughter, applause]

The stupidest part of Giuliani's involvement

is that he did this in plain sight.

Back in May, he told "The New York Times..."

And even now, he insists he did absolutely nothing wrong.

- Giuliani just did an interview

with "The Atlantic" this afternoon.

He seemed very angry, according to the reporter,

and he said, quote...

- No, you will not be. And I'll tell you why.

Because you will still be Rudy Giuliani.

Best-case scenario here--

you'll one day be one of the masked singers.

People will briefly not know that you are Rudy Giuliani,

and you will nearly be the hero.

But eventually, you'll have to take your mask off,

and then you'll be yourself again

for the rest of your life, and it will be fucking terrible.

Now, Giuliani's role here

is actually unusual for lots of reasons.

He is not working for the government.

He's Trump's personal lawyer.

And he's not actually being paid.

He's working for Trump for free.

Now, why is he doing that?

Well, he's actually going through

a characteristically messy divorce

from his third wife, a woman with whom he has

uncharacteristically very few great-grandparents in common,

and, at least according to her, he's working pro bono

in order to reduce any future alimony.

So the president is paying Giuliani nothing,

and yet, I would argue, he's still overpaying here.

And incidentally, one of Giuliani's reported complaints

against his wife is that she, and I quote...

Leaving him limited to using his iPad to watch TV.

Because Rudy Giuliani,

cybersecurity expert and Donald Trump's lawyer,

is seemingly unaware that you can buy new remote controls

at Best Buy.

But, look, to recap here, it seems the president

pressured a foreign head of state

to investigate his political rival,

then his staff tried to cover it up.

And perhaps the most shocking part of all this is

it might actually hurt him.

And I know that you're probably thinking right now,

"No, it won't, you fucking idiot.

Nothing Trump does ever affects him."

And I do get that.

That has clearly been true, until maybe now.

Because people seem legitimately furious over this.

The House has opened an impeachment inquiry,

and even a few Republicans

seem to be treading with caution for a change.

And it kind of does make you wonder, why now?

The president's done so many terrible things.

Why does this one count?

And it's hard to say, but it might just be

that this one is simpler in some key ways.

'Cause unlike Trump as a candidate

asking Russia to find Hillary's emails, "if they're listening,"

this involves him abusing the power of the presidency.

Unlike the meeting with Russians at Trump Tower,

this time, Trump was undeniably personally involved.

Unlike the multiple potential violations

of the Emoluments Clause,

we already have hard proof that this happened.

Unlike Trump's treatment of migrants, he can't claim

this is just a difference of political opinion--

he pressured Ukraine to gain something for himself.

And unlike the Mueller Report's

legalistic descriptions of obstruction of justice,

Trump pressuring Ukraine to get dirt on his opponent

and then hiding the conversation

is easy to understand.

It's just gettable.

You don't need to know any more than that

to know it's something

presidents should absolutely not be able to do,

just like how they should not sell the White House

or suddenly change the National Anthem to this:


♪ ♪

That guy might be a key player

in the impeachment of an American president!

What a fun time to be alive!

And, look, when you put all of that together,

this particular Trump scandal

does start to feel a little different

and something that is

absolutely meriting of impeachment,

especially because the fact that it is so consistent

with all of Trump's other behavior

suggests that it is a pattern that will continue

until he leaves office, one way or another.

Because at this point

it has just become painfully obvious that Trump--

much like all the TV channels in Rudy Giuliani's house--

simply cannot be changed.


And now this.

- There it is, written by your own staff,

and yet nothing happened.

- They closed the case.

- They closed the case.

[dramatic music]

- You're not allowed to run. - I'm not allowed to run.

- Because of this law. - Because of this law.

- The bad results. - Bad results.

- It's possible. - It's possible.

- It's heavy. - It's heavy.

- This is the blind mouse. - This is a blind mouse.

- This is it? - This is it.

- This is Mission Control? - This is Mission Control.

- And this is what's revealed.

- And this is what's revealed.

- All volunteers. - All volunteers.

- Out of nowhere? - Out of nowhere.

- Pill spill. - Pill spill.

Huge pill spill.

- Tuscany in a box. - Tuscany in a box.

- Chateau Rudy. - Chateau Rudy.

- Look at your own numbers. - Look at your own numbers.

- And he's only 23. - He's only 23.

- Tires. - Tires.

- That's a lotta kids. - That's a lotta kids.

- You got a good, comfortable chair.

- You got a good, comfortable chair.

- You were a handful. - I was a handful.

- The dynamic changed. - The dynamic changed.

- The office was more important than the man.

- The office is more important than the man.

- Human stories are human stories.

- Human stories are human stories.

- We got Ned's head.

- That's Ned's head? - That's Ned's head.

[clock ticking]

- Moving on.

For our main story tonight, let's talk about pharmacies.

You know, those places that let you arm-fuck a robot.

Or, as some people insist on calling that,

"getting your blood pressure taken."

Now, when you picture a pharmacy in your mind,

you probably imagine a place

that your doctor calls in a prescription

and someone counts out pills

that were manufactured somewhere else,

but that is actually a relatively new phenomenon.

A lot of pharmacies used to make medication on-site,

as this old film shows.

- A doctor's prescription may seem mysterious

to the average layman,

but it's all very simple to the pharmacist.

It is his responsibility to make sure

that each prescription is filled

exactly as the doctor has ordered.

An error in the compounding of a prescription

could be injurious or even fatal to the patient.

- [snooty voice] "Yes, any error could be fatal,

"which is why we only hire nearsighted men

"to eyeball ratios out of a series of identical bottles.

"And if that doesn't work, do feel free to die.

Happy 1940s to one and all!"

And while that is obviously no longer how it works

in your local CVS, there are places

that do still make their drugs from scratch on-site.

They are called compounding pharmacies,

and they exist for a very good reason.

- Compounding pharmacies make medicine for people

whose needs cannot be met by an FDA-approved product.

Let's say you're allergic to a specific ingredient in a pill.

Your doctor can write a prescription

tailored to your specific needs,

and a compounding pharmacy will mix it.

- That's right.

Compounding pharmacies basically make bespoke medication.

I'd say "designer drugs" if that phrase hadn't already been taken

by egregiously Dutch dealers selling pills to suburban kids.

"Dish ish da good shit. Trusht me.

"It's gonna shend you to outer shpace.

It's for your dance par-teez."

There's actually around 7,500 compounding pharmacies

all over this country,

and they can fill highly specific prescriptions

for all sorts of reasons.

Maybe you're having trouble swallowing pills.

They can make the same drug in liquid form.

Maybe you need a drug in a lower concentration

than what's commercially available.

They can do that for you. So they do very important work,

and it is not just humans that benefit.

- There are no manufactured medications made for birds.

So you need to go to your compounding pharmacist

so they can make the right volume,

because it could be large... - Oh!

- Medium... - Eh.

- Or small. - Ah.

- Each one might like a different flavor

or require a different volume.

She likes piña colada flavor.

[laughter] - Does she?


A tropical bird whose favorite flavor is piña colada?

Look, I'm just gonna say it: that basic.

Ya basic.

You're a basic bird.

So at this point, so far, so good.

But as you've probably guessed from the very fact

that we're talking about this story in the first place,

there are some huge problems here,

because compounding pharmacies are subject to

much less oversight than large drug manufacturers.

If you get a drug that was mass-produced in a factory,

both the drug and the factory are under a lot of scrutiny.

But if you get one from a compounding pharmacy,

it is very different,

as a former head of the FDA will tell you.

- Compounded drugs are not FDA approved.

- As commissioner of the FDA, then,

you can't tell us, sitting here now,

that every drug being used in the United States

is safe and effective.

- No.

I-I really cannot.

- Holy shit.

That's kind of startling to hear, isn't it?

And look, on one level, it does make sense

that if compounding pharmacies are making bespoke medication

the FDA doesn't treat them like they're a giant manufacturer.

You know, you wouldn't subject Mikey's lemonade stand

to the same regulations Coca-Cola has to obey

for mass-producing Minute Maid,

because that would be overkill.

And besides, even if Mikey did pee a little bit

in his lemonade--which, let's face it, he definitely did--

the damage is inherently limited.

But, as you will see, oversight is so lax

that compounding pharmacies have become

the Wild West of the drug industry,

resulting in fraud and, in the worst cases,

many, many people dying.

And you may not even know

that you're taking a compounded drug,

'cause they can be used in clinics or hospitals

without your or your doctor's knowledge.

So tonight, let's take a look at this industry.

Let's start with the fraud.

A few years back, Tricare,

the military's health insurance program,

noticed a big increase in being billed

for veterans' specially compounded

scar and pain creams.

But there was a problem,

as man who oversaw the program admitted.

- Are these creams a viable alternative

for treating the pain of wounded warriors?

- They don't appear to be.

We don't have any evidence that supports that.

- And he was right about that.

Those creams were total bullshit.

One study found they didn't work any better

than treatments that contained no medicine at all.

And it's shocking that that was allowed

and it is why I'm excited to announce

my amazing new pain cream, Johnny Gel.

It's great for relieving

tenderness in your back, neck, and joints,

and yes, it is just mayonnaise.

Ask your doctor if Johnny Gel is right for you.

Now, what happened was,

a number of compounding pharmacies realized

that there was a loophole where they could bill Tricare

for the cost of each individual ingredient in their creams,

so they simply added as many expensive ingredients

as they could, and by the time

the military realized what was happening,

the costs had gotten ridiculous.

- It's just been an astronomical,

an explosion of the charges

in a relatively short period of time.

We're on track this year to spend over $2 billion

unless we get our hands around this--2 billion.

- $2 billion!

When we talk about overspending in the military,

I don't think anyone would've guessed

a not-insignificant chunk of that

has gone to fucking lotion.

And unfortunately, even when there isn't fraud,

it is not rare for compounded medication to be ineffective.

When the FDA tests drugs from commercial manufacturers,

the failure rate is typically below 2%.

But when they ran tests on compounded drugs,

around 33% of the drugs failed.

That's one in three!

To put that in perspective, compounded drugs

have about the same failure rate

as the Jonas Brothers.

We all know--we all know which one I'm talking about.

And it is not you, Kevin.

You are doing great.

[quietly] Shh, come on, guys,

he's been through enough.

[normal voice] You're doing really great, Kevin.

You're actually my favorite.


But a drug simply not working

is by no means the worst-case scenario here.

Because while, again, you would not expect the FDA

to be testing every small-batch drug made,

you would at least hope that someone was making sure

the places they were made were clean.

But conditions can be appalling,

as multiple investigations have found over the years,

with some particularly revolting examples:

- In one Miami pharmacy,

a compounded drug for lung disease

was found in the same refrigerator

as the employees' lunch.

At another pharmacy,

compounded drugs were stored in the employees' bathroom.

- It sickened me. It really did.

It bothered me a lot.

- Yeah.

It should have sickened you,

'cause you should not store an open box of loose pills

next to a toilet.

I've never been to pharmacy school,

but I'm pretty sure lesson one is

"don't put the pills where you poop."

So how could that happen?

Well, in the absence of FDA oversight,

state pharmacy boards are supposed to send inspectors

to make sure conditions are sanitary,

but in many states,

there is an extreme shortage of them.

As of 2016, Hawaii had only one inspector,

Kansas had two,

and Illinois had just three,

despite the fact it has nearly 2,700 pharmacies,

meaning each inspector would have been tasked

with 900 locations to keep an eye on.

And the only way that is possible

is if the inspectors are just texting each pharmacy,

"U good?"

And this lack of oversight can be especially dangerous

if a lab is producing sterile drugs

that are injected into the body.

A few years back,

one compounding pharmacy made national headlines

after it was found to be the source

of a massive meningitis outbreak.

- The Food and Drug Administration

is telling doctors don't use any products

from the New England Compounding Center.

You know, when they went in there,

they actually found fungus in a vial

that you could see... - [gasps]

- With the naked eye.

They saw some guck, for want of a better word,

in it, they put it under a microscope,

and it was a fungus.

- That is disgusting.

The only worse thing to find in a vial of medicine

than visible "guck" would be a visible duck.

'Cause, putting aside the issue of hygiene,

how did you miss this?

How did you not hear the quacking?

Your oversight's a fucking mess!

And while it would've been comfortably bad enough

if that pharmacy, NECC, was just making drugs

for individual patients,

it was actually producing medication in bulk--

the thing, remember, it was absolutely not supposed to do.

Compounding pharmacies are supposed to do small batches

based on individual prescriptions.

But NECC skirted those rules to make more money,

shipping their gucky medication to 23 different states,

eventually killing more than 100 people.

And it's a little weird

that you don't remember that story, right?

Although to be fair, it was 2012,

and we were all distracted

trying to find Kony at the time.

Where's Kony? Did we get him?

Did we get Kony? Does anyone remember?

It seemed so important at the time.

I bet we got him.

We wouldn't have just given up, would we?

And, look, while regulations required them to have

an individual prescription for each patient,

they managed to get around that

by simply faking patient names

and not even seeming to try that hard.

- Investigators also allege

that employees falsified prescriptions

with fake names like...

- Oh, come on!

"Bud Weiser"?

It's like they were trying to get caught.

And it didn't even stop there.

They also filled prescriptions with names--

and this is real--like...

That is such a gloriously random group of people.

Most people would see no connection between them,

unless you are me, and you have some very specific,

very bold theories about who killed JFK.

I've nearly cracked it. None of you leave the country.

I think there may have been a second Schwimmer.

This scheme, though, was incredibly lucrative.

In fact, the President of NECC, Barry Cadden,

made over $60 million

in the three years leading up to the outbreak.

And he seemed to know what he was doing was wrong,

because he was once asked

at a filmed employee training session

about keeping records of patient names and prescriptions

and his answer was comically suspicious.

- Is it one-to-one patient names

for the bulbar blocks?

- Um...

that's something for another time.

Yeah, let's not--that's--

We can talk about that.

Those--that's actually one of

the more difficult things we do.

Let's just talk about the products now--

- Okay, that's fine. - While we're being recorded.


- Okay.

If you're being recorded saying you don't want to say something

while being recorded, you've probably already said too much.

"All right, so this is where we keep the guns,

"the ski masks, and the big bags of money

"with dollar signs on them.

"Where does that money come from?

"Well, I probably shouldn't talk about that

while we're being recorded."



The defining hallmark of NECC was just how clearly

everyone knew that they were breaking the law.

At one point, the company's national sales director

even sent out an email with the unassuming subject line

"huuuuuuge importance"

which reads, in part...


Which is an incredible thing

to put in writing.

Now, thankfully, Cadden eventually went to prison,

and Congress passed a law

toughing up enforcement of regulations

among compounding pharmacies, which is theory.

The problem is, they wrote in some massive loopholes.

For instance, the law required any pharmacy that wanted to

mass-produce drugs, you know, the way that NECC did,

to register as something called an "outsourcing facility"

and submit to much stricter inspections,

but it made doing so completely voluntary.

And if you need everyone

to obey a rule,

it just can't be voluntary.

It's why stop signs say "stop" and not "shrug emoji"?

And so, perhaps unsurprisingly,

only 77 facilities are currently registered.

That's just 1% of compounding pharmacies.

And because the FDA had no system to catch violators,

many pharmacies just carried on exactly as they were,

with some being pretty bold about it.

How bold? Just watch this.

- The FDA's inspection of Downing Labs in July found...

Ashley Downing is the co-owner of Downing Labs.

They asked you to recall your sterile products.

- That's correct. - And you decided what?

- No.

- Just "no." That's it.

She responded to a request for a drug recall

the way most of us responded

to seeing the trailer for the movie "Cats."


"I refuse to acknowledge that this is happening.


[cheers and applause]

Now, she claimed the FDA had no jurisdiction over her

and that she'd followed all state requirements,

but the FDA disagreed,

and while they eventually did manage to force her to comply,

that didn't happen until almost a full year

after that interview.

And when oversight is this weak,

compounding pharmacies can hurt large numbers of people

for a long time.

Just look at what happened recently in Texas

with a company called Guardian Pharmacy Services.

This is it here.

They apparently mass-produced medicine

which was injected into people's eyes

and which turned out to contain formaldehyde and acetone--

two things pretty high up the list

of things to keep away from your eyes

right above jalapeno peppers

and just below the trailer for "Cats."

No. I said "no."

Now, Guardian didn't opt in for FDA oversight,

so it was regulated at the state level,

but not, it seems, very well,

because nearly 70 people who were injected with their drugs

are now partially or completely blind.

And yet it took six months from the first injections

for state regulators to even be notified

that there was a problem,

which is something understandably frustrating

for the people who ended up losing their sight.

- By the time Susie Pope

went in for cataract surgery at a Dallas eye clinic,

dozens of patients had gone before her.

- How could 68 people be involved

before they pull that off the shelf?

- Many of them have the same question.

- We notice real quick how, when lettuce is bad,

we pull it off the shelf every week.

- Yeah. and of course, he's right.

It's frankly not unreasonable to want a world

where you can feel confident

that something that's about to be injected into your eyeball

is at least as safe as lettuce.

'Cause I'll tell you what is as safe as lettuce,

and that is Johnny Gel.

I have to say, Johnny Gel may not be as safe as lettuce.

And yet, incredibly,

not only did the Texas State Pharmacy Board

not shut down Guardian,

they haven't shut down a single compounding pharmacy

in at least five years.

Now, you should know,

they did put Guardian's license on probation,

but the man behind it simply shut it down

and opened up a pharmacy called Medical Park Pharmacy

at the exact same location.

So their door simply changed from this to this.

And it is hard to notice any meaningful differences there,

even if you weren't recently blinded

by some tainted eye medication.

And look, again, compounding pharmacists

play an important role, but that is all the more reason

why they should be properly regulated.

So at the very least,

we need more inspectors at the state level,

the outsourcing facility designation

should not be voluntary,

and compounders should have to alert regulators

whenever they fuck up.

And until then, bad facilities could probably really benefit

from a message from some of the very real names

that they've thrown around in their nonsense prescriptions.

- Hey, I'm David Schwimmer.

- I'm Method Man.

- I am obviously RuPaul.

- I'm Jimmy Kimmel,

America's favorite late-night host.

By far.

- And I'm the one and only Michael Bolton.

- And we'd like to say a few words

to compounding pharmacies.

- Please don't use our names in your bullshit prescriptions.

- We're not just random words to be thrown around

so you can evade the law.

We're real people.

- Well, some of us are.

Like me, Jack Bauer.

- And me, Sarah Marshall.

- Who? - [scoffs]

Do not tell me you forgot Sarah Marshall.

- Oh!

You're the one who broke up with Jason Segel's dick.

- Sure did. - [laughs] Girl...

- The point is, we're mad.

- Real mad.

- Because our names don't belong

on your fraudulent spinal medication.

- Mine belongs on a platinum album.

- Mine belongs on the list of

America's top pretend paleontologists.

- And mine belongs on the Emmy

for outstanding variety talk series

that somebody else keeps winning over and over again.

- So stop using our names to turn your compounding pharmacy

into an unregulated drug manufacturer.

- And while we're at it, don't even think about

trying to sell us any of that $15,000 skin cream.

- We don't want to be involved in your lotion scam.

- No, no, no, no, no, no, honey.

I'm not getting mixed up in your ointment scheme.


- And if you're an outsourcing facility,

let yourself be regulated like one.

[music winds down, stops] Because if you don't...

- I will tie you up in a dark basement in a black site

in southern Turkmenistan, and I will inflict

a level of pain on you you could not imagine

in your darkest, most terrifying nightmares!

- Jesus Christ.

- But even more importantly,

we need to make sure that compounded drugs

are coming from labs that fully comply with safety guidelines.

- Because keep in mind,

lots of people need compounded drugs.

- And it's not just people.

My bird needs them too.

- Yeah, my--What?

Michael Bolton has a parrot?

- Of course I do. I love parrots.

Do people not realize that

"How Am I Supposed to Live Without You"

is about a lady parrot?

I loved that parrot.

And she left me. [sad music]

- She did leave him. [chuckles]

For me.

Fuck you, Michael Bolton.

- Yeah, fuck you, Michael Bolton.

- Fuck you!

- And finally,

until you're better regulated,

you should stick to what you were designed to do.

- Making piña coladas for birds.

- I miss you.


- What the fuck?


- That's our show. Thanks so much for watching.

See you next week. Good night!

- Girl, look, I-I'm a queen, okay?

So I've been involved with some real shady schemes, okay,

but I'm not getting mixed up in some shady ointment scheme.

Ointment scheme?

Ointment scheme?

[scoffs] Puh-lease!


Look, I'm not opposed to schemes.

I'm a queen!

But I'm not getting mixed up

in some shady ointment scheme.


Ointment scheme?



[bright tone]

The Description of September 29, 2019