Why the drug industry has to change – Docu

Why the drug industry has to change – Docu


We take ever more pills. The pharmaceutical industry’s
profit machine is running at full speed. Attempts to make medication cheaper
get deadlocked in the system. But health care premiums keep rising,
to the detriment of patients. What’s wrong with the system?
How can it be improved? Four passionate pioneers fight,
each from their own expertise… …for new ways to keep medication
affordable for everyone. Many companies base their price
on cost plus a fair profit margin. In this case they go
for the maximum return. And with drugs that’s very annoying
since everyone wants them. The system as it operates now
is very agreeable to them. They sell drugs that are ineffective
in 70-80% of patients. It’s close to incredible. I think our governments,
including the Dutch government… …should show much more guts,
much more courage… …to intervene if companies won’t make
important drugs available at a fair price. This is Backlight. Welcome
to the world of wealth and health. The Dutch use a lot of medication. It shocks me to see these huge
amounts that arrive in the morning… …and then to think:
that’s what we ordered on just one day. Pharmacist Paul Lebbink
runs a pharmacy in The Hague. He acquired fame
by copying expensive drugs… …at only a fraction of the price,
to the chagrin of the industry. Why do we take so many pills? This is for blood pressure. I think medication is often prescribed
and given out automatically. Industry research focuses on proving… …that the use of ever more medication
has an added value. Less might be much better
for our health. Look at this package,
a big bag for one patient. This is for just three months. Each pharmacist wants to help patients
and the worst that can happen is… …that you can’t provide a drug because
it’s too expensive or unavailable. I see it as my primary task to ensure
that the patient can get the medication. Those are sachets with a powder
that has virtually no side effects. Lebbink is frequently faced
with new expensive drugs… …which he could produce himself
at much lower cost. The pharmaceutical industry is
now focusing on rare diseases… …developing medication for them
at a very high price. If something is so expensive that
patients can’t afford it, it’s no use. So that’s a good reason to think:
if I were to make this myself… …would that lead to a price
the patient can afford? Until the early 20th century
pharmacists made their own drugs. Only in the 30s, 40s, 50s
did the industry emerge… …introducing processes
for larger-scale production… …of pills, capsules and powders… …so that pharmacists
produced less and less. I think 2-3% of the drugs
we provide to patients… …are prepared
by pharmacists themselves. We can’t go much lower since the
industry can’t provide customized drugs. That wouldn’t be profitable for them. Plus there are compounds that a doctor
would like to try out before it’s a drug. This is a product we make here:
morphine cream. A doctor had a patient
with many bedsores. And none of the drugs he prescribed
sufficiently eased the pain. He wanted me to make morphine cream
for application on the wounds. So there’s no company
that produces this cream. No. There’s not enough evidence
that it would be effective. Several of our patients report
that the cream decreases their pain. But that doesn’t count
as scientific evidence. And you’re allowed to prepare it?
– Yes, as a pharmacist I can do this. We can give this to patients who
use it as medication for themselves. In 2007 I was summoned in court
by Orphan Europe… …because I had prepared a compound
they had put on the market. They argued that I should have given
this patient their product. I disagreed. I found their price way too high:
150,000 euros a year per compound. Our price was 3000 euros.
The ingredients are not that expensive. This compound was initially bought
from the paint industry. We had produced it because
this boy lacked an enzyme. The judge cleared me on all counts. He said: A pharmacist can make a drug
for his own patients… …even if the patent on this drug
has not run out yet. The doctor should then
prescribe it generically. So you can’t use the name
that was patented by the company. Under a generic name pharmacists can
make medication for their own patients. Did they put any pressure on you? They certainly did.
They visited me several times. But it was all done in a more
or less decent way, fortunately. To get a better understanding of the pill
industry we speak to Peter Gøtzsche. For ten years this Danish doctor
did marketing and research for Astra. He became a whistleblower… …and is now known for his thorough
critical studies on the pharma system. The unreliability of data led Gøtzsche
to set up the Cochrane collaboration… …a famous network for independent
research into the effects of drugs. The online database is now consulted
from all over the world. We have come to the conclusion that
pharma companies charge excessively. And the money paid to them
can’t be spent otherwise. Access to health care, an internationally
recognized human right… …is therefore endangered,
since too much is spent on medication. Jan-Koen Sluijs is a solicitor. He was
shocked by the prices for new drugs. He often litigates on behalf of big
companies in competition cases. Now his team is looking for a way… …to legally force pharma companies
to decrease their prices. These Actavis hydrocortisone tablets,
I have no idea what the benefits are… …are very expensive,
120 times as much as before. What motivates you? It may sound pathetic,
but I fight against injustice. This is a kind of new revolution:
how to keep our society in balance. They often talk about innovation,
about development costs. It’s time to put that behind us. Over the past two years
we’ve seen more and more research… …putting this in doubt and arguing… …that development and production
costs are far lower than they say. The problem is that we pay
and continue to pay through the nose… …without any need, for why
should they make such huge profits? This Gilead hepatitis C medication
is a prime example. They were the first on the market.
Development costs were moderate… …as they bought it
from a spin-off company. They made some minor changes, put it
on the market and made huge profits. Exactly. This is wrong.
I think everyone agrees about this: The budget for specialist health care
goes up by 1.5% a year, as agreed… …but virtually all the extra money
is spent on price rises for medication. I don’t want to put it too dramatically,
but I think the result will be… …that your hospital bed is
a mattress in the corridor… …since the building…
– But with good medication. Yes, you’ll get a lot of great drugs
but you’ll never see a doctor. We pretend it’s normal
to go for maximum profit. But most small companies in this
country base their price on the cost… …plus a fair profit margin. In this case
they go for the maximum return. And with drugs that’s very annoying
since everyone wants them. You should honestly assess
whether this is a fair price. So market forces don’t correct this?
– It’s only a free market in the sense… …that the company sets its price,
and in the end… They use the system in order to…
Well, they abuse the system, basically. So either the market
should be opened up completely. No patents and so on, just tough
competition. That’s one option. Or the government should say:
From now on we set the prices. But how can you argue
that the current system is illegal? Exploitation of clients is a type of abuse. We, our foundation,
want to go one step further: Can’t you appeal to human rights… …and say that pharma companies,
through their excessive profit margins… …block access to health care? Is there a right to cheap medication?
– No, there isn’t. But there is a right to accessible,
affordable and high-quality health care. And if need be,
we go to court to achieve this. I can’t rule out that we will. The sector has not really proven
that it is open to change. A court case
against a pharma company. Total global turnover of the pharma
industry is almost 1000 billion euros. One trillion euros per year. The list is headed by Roche from
Switzerland and Pfizer from the US. My specialism is the treatment
of pancreatic cancer. On average Dutch patients live six
to nine months after being diagnosed. After five years
the survival rate is 5-6%. It’s very aggressive, the second cause
of cancer deaths in the Netherlands. Currently more patients die
from pancreatic cancer… …than from breast cancer or cancer
of the large intestines: 8-10 per day. Casper van Eijck
is very independent-minded. The Feyenoord team doctor
is a respected researcher. He treated patients from around
the world, including Steve Jobs. Chemotherapy is effective
in only a limited number of patients… …while it generally has
many adverse effects… …very harmful adverse effects. My personal motivation is
to stop this aggressive form of cancer. We’ve worked on that for 25 years
and haven’t made any real progress. That should change, especially
with this aggressive form of cancer. Pharma companies
are very risk averse. To Van Eijck’s frustration
progress is too slow to save his patients. That’s why he himself is eagerly
trying to find new drugs… …that do work
against pancreatic cancer. By now every scientist, be it in the
Netherlands or the US, is convinced… …that all forms of cancer
are curable in mice. For our patients that’s not yet the case,
unfortunately. So at Erasmus Medical Centre
our emphasis is… …on so-called clinical research,
research in patients. That’s expensive
but you need to facilitate it… …because it brings progress and you end
up with so much expertise in hospital… …that pharma companies can never claim
their development costs are very high… …as all the work will be done
in hospital. That’s a way to keep
the price of medication low. It has always been my principle
to keep the industry at a distance… …to avoid the danger
of becoming dependent on them… …concerning the prescription of drugs
or whatever. I don’t like that at all. Whenever pharma companies
approached me I said: I’d rather get funding for research
than expensive trips or dinners. Those are really a waste of money. A lot of people
have personal motivations. In most cases
they have lost relatives to cancer. My father died from it
at a very young age. That gives you a certain drive… …to try to achieve something
with your team. Two times sixty.
– That’s right. Okay, fine. What kind of drugs are these?
– Cytostatics, for chemotherapy. Yes, 17 ml. That’s right. These compounds are poisonous,
so if you work with them all day… …you need protection. This is one of our expensive drugs,
ipilimumab, a real tongue twister. One dose for one patient
costs around 17,000 euros. We often give an additional drug,
nivolumab… which also costs
several thousand euros… so the cost of this combination is
about 25,000 euros per “drip day”. Patients get it once every three weeks
as long as they don’t react badly to it. So it may continue for several months.
For some patients the results are good. But it’s not a real cure. It only slows down the disease.
It doesn’t make it disappear altogether. What’s the value of this box?
– Its contents are worth a fortune. Why do we continue to pay
so much money… for cancer drugs that are ineffective
for so many patients? The system as it operates now
is very agreeable to them. They sell drugs that are ineffective
in 70-80% of patients. It’s close to incredible. So for a very large group of patients
who get chemo therapy it’s useless. Big pharma couldn’t care less
that most patients don’t benefit from it. And that should really be stopped. Why does chemo work for some
but not for others? That’s what Casper van Eijck
wants to find out. But the industry won’t fund
that kind of research. I can imagine that it’s not
in the interest of pharma companies… …that doctors can predict
whether a drug is effective or not. It would mean that 60% of pancreatic
cancer patients won’t take this drug… …decreasing their turnover
by 30 to 40 million euros a year. There are so many opportunities
for clinical research. And I think we should use
more of those opportunities. In my own patients I notice
that virtually all of them say: If it doesn’t help me, I would still
contribute to other people’s future. This social way of thinking is unique, I
think, for the Dutch patient population. Hello dear Casper, this video
is the last time you’ll see me alive. The FOLFIRINOX therapy
that I opted for a few weeks ago… …as you will remember… …has sapped me to such an extent… …that one of these days
I will die from a complication. One of the things that are bugging
me is: I should tell Casper van Eijck… that I can no longer take part
in his wonderful research project. But please continue
on this promising path. I’m fine and I wish you all the best.
Bye. I say: Why don’t we make it obligatory
for pharma companies… …to help fund research
aimed at predicting… …if someone will benefit from chemo
or not. I call it a chemo tax. I think it’s important that pharma
companies think along with us… …but also help fund research… …aimed at avoiding a very tough therapy
if it’s not effective. We also pay road tax
because we pollute the air. Chemo tax.
– I think it’s quite a good idea. But how can we achieve that?
We ask patent attorney Ellen ‘t Hoen. For thirty years she’s been advocating
a fairer system for drug pricing. I’m a solicitor and my area of expertise
is access to medication. Initially, I mainly worked in developing
countries, where the problem was huge. But my focus has shifted
to rich Western countries… …because drug prices
are going up everywhere. In the 90s ‘t Hoen was involved
in the successful fight… …to make aids medication
affordable and available in Africa. This helped save millions of lives. At the time aids medication
cost 15,000-20,000 dollar… per patient per year. Hardly anyone
in Africa had access to it. Each day 8000 people died,
and in those circumstances… …pharmaceutical companies
decided to sue Nelson Mandela. Everyone said:
Now they’re really going too far. As soon as you try to get down
the price, they’ll always say: Then we won’t be able to develop new
drugs, since that’s very expensive. It’s true that it’s expensive,
but we don’t know how expensive. That’s unclear. Companies should be
asked to provide information about it. This could be part
of government policies… …regarding national insurance coverage. Here Ellen ‘t Hoen gets her Ph.D.
for research that describes… …how governments can waive patent law
in the interest of public health. The Dutch government can’t drive a
hard bargain with pharma companies… …because it’s very difficult
to negotiate with a monopolist. But the government could say:
The price must go down… …or we’ll ask someone
to produce it for a lower price. Then the power dynamics in these
negotiations would be totally different. The government should do that
much more often. We pay around 40,000 euros
for hepatitis C drugs… …that cost 60 euros to produce. That’s patently unfair.
So the government should interfere. Could the government do that
in the current situation? Yes, according to Dutch patent law
the government can take up that role… …as I describe in my dissertation. At a European level
it would require some action. But if countries make better use
of their patent laws… …in the public interest… …the move to adjust these medication
regulations will follow automatically. Medication law is aimed
at making drugs available… …not at withholding them from patients,
which sometimes happens now. I think our governments
should show much more guts… …to intervene if companies won’t make
important drugs available at a fair price. In his search for effective drugs
Van Eijck is pushing the boundaries. The government can make new drugs
available only after a long testing period. So Van Eijck approached
entrepreneur Ronald Brus. His startup helps doctors and patients… …in acquiring experimental drugs
from around the world without delay… …even if they have no official approval. This compound works very well,
especially in the beginning. I’ve seen the data
from the US mouse studies. We’d like to see exactly how
these studies were carried out… …and to assess whether this is feasible
for our patients. In the Netherlands immunotherapy
costs 70,000-80,000 euros on average. Since this drug has not been approved
it’s not covered by any insurance. What’s wrong with the system? The system has contributed
to the situation… …that all new drugs are very expensive… …and that it takes very long
for a drug to become available. Those two things have been revealed… …thanks to the internet and the expertise
of doctors and patients worldwide. People see that a drug shows great
results in one country and wonder: Why can’t we get it here? And we’ve also started asking:
Why are drugs so expensive? Brus made his fortune
with the Crucell biotech company. Now he’s a pioneer
in the new form of data-driven pharma. I’m a doctor. For thirty years I did
pharma research into drugs. And then, a number of years ago… …my father’s illness made me look
for new medication for him. As the CEO of one of Europe’s
biggest biotech companies… …I had friends in the pharmaceutical
industry who led big companies. One of them was developing a new drug
and offered it to me. Then I thought:
This is a great chance for my family. But why shouldn’t others
also get that chance? Then I found out how hard it is,
even if we know a drug is effective… …to get it to Holland, so I founded
myTomorrows to facilitate that. We’re currently active in 22 countries. Each month you lose is a lost month,
for you and for your patients. They’ll never get it back. I still think this is the path
we should follow: We should make it clear
that it’s very important to us… …to monitor the effect of a certain drug
in a limited group of patients. The government should also help us
regarding the availability of drugs. People will only make things available
if they get something in return. If a pharma company is forced
to hand something over… …without getting anything in return,
it won’t work. I think the current system
will eventually break down. Doctors and patients around the world
want to have access to those data. The companies that make those data
available will be the most successful. It can’t go on like this:
developing things in secret… …without sharing them with the patients
and doctors who helped you do that. With the current expertise, which can
be shared with billions of people… …that’s no longer accepted. What do you say as a doctor?
How would a new system work? How would these drugs
be produced and priced? The ideal system is one
led by doctors and scientists… working in tandem with health
insurance and pharma companies. That would be my ideal. Then we
could make big strides very fast… …and it would all become much cheaper,
since we could assess in advance… …whether drugs are effective or not,
which is very important. Van Eijck is in a hurry:
each day patients die. In the Erasmus medical centre
he’s taking a revolutionary step. Together with virologist Ron Fouchier
he’s developing his own cancer drug. We had budgeted virus production
at 650,000 euros per badge. What’s included in that?
– Everything. We are going over the business plan
for the virus production facility. We want to produce
these viruses ourselves. So you’re making a new drug. We’re developing a new drug
on the basis of viruses. We try to do that
without industry involvement… …with the help of science funds
and crowd-funding actions… …so that we are in control. What will it cost
to develop this virus therapy? I think if we add it all up
and we would… …we could use the very first badge
we make for a clinical study… …our total cost would be
10-15 million euros. How do you get funding? Mostly from the Support Casper
campaign… …a foundation set up
by next of kin of deceased patients. That way we’re largely independent. The industry takes a great interest
in our research. They’ve already asked us
to show them how we’re doing things… …since the industry will see us
as a competitor. So pharma companies are certainly
interested in what we’re doing. In the first year, when we’re renovating,
we won’t need a 0.5 fte pharmacist. You need a technician to scale up
from 10 millilitres to 10 litres. What’s the role of this quality official? I wouldn’t know. That’s actually
directly related to your IMPD. If this virus therapy proves effective,
will you apply for a patent? We already started the application
procedure for a number of viruses. We only do that to ensure… …that the price can’t be driven up
if it should prove effective. After two years of toil
to get the project off the ground… …we now have an actual case. “Exciting” may not be the right word.
It’s a memorable day, it really is. We can’t uncork the champagne yet,
but this is what we’ve been waiting for. What’s in today’s paper? Foundation seeks fine for pharma
company over price increase. That’s today’s goal. We’ll ask the ACM
to act against Leadiant… …the pharma company
that in ten years’ time… …made its product
500 times as expensive… …as the original drug
that was already on the market. ACM?
– Authority for Consumers and Markets. They see to it that companies
don’t abuse their position of power. We have established that Leadiant
had a trade permit for this drug. It bought the existing drug here
and scrapped its registrations… …so that others were not allowed to sell it. Then they increased the price, from
30 cents to 140 euros per capsule. That’s 150,000 euros per year
per patient: a huge difference. Tie a ribbon around it. After a long career
this is something of which I think: As a solicitor I can make a difference
here. It has an activist element. I may not look like an activist,
but in this case… …I’m involved in activism. You always hear that it’s all very bad… …but that these companies act
within the confines of the law. They endlessly repeat that. But I’m convinced that they don’t act
within the confines of the law. Of course you’re allowed
to take over a company. But you can’t abuse your position.
They act improperly. They violate the due care principle. That’s also part of the law. But you
need judges who pronounce that… …and solicitors who present this view
on behalf of a client. But this is step one,
and I think it’s a fairly clear-cut case. Everyone who’s not involved will agree… …that an increase from 30 cents
to 140 euros is unacceptable. But more is needed
to change this behaviour. That’s our goal, to change the behaviour
of these pharma companies. Let’s see. It’s quiet. They’re all having lunch now. There we go. Good afternoon.
– Our foundation, this is our chairman… …wants to ask ACM to act against
a pharmaceutical company, Leadiant.

28 comments

  1. On VPRO broadcast you will find nonfiction videos with English subtitles, French subtitles and Spanish subtitles, such as documentaries, short interviews and documentary series.

  2. "If a drug company finds out that celery juice lowers blood pressure and if they tell it to people, they can't sell their drugs. They get three bucks for a pill. Why should they tell you to use celery juice?
    The free enterprise, monetary system is corrupt as hell because of the nature of business."

    Jacque Fresco

  3. Most of the diseases people suffer from are a direct result of bad lifestyle. For example, diabetes type 2 can be cured in less than a month by switching to a plant based diet. Many scientific studies and lots of patient reports back up this claim. But no physician will inform their patients, simply because they don't even know themselves. Doctors are trained in university on a curriculum managed by the pharmaceutical industry.

  4. Es muy importante lo que comemos y el agua también tenemos las plantas cómo remedios solo que no se quiere saber nos quieren tontos para manipular mas fácil

  5. This documentary has a definite agenda, as opposed to telling all the problems in the industry. When talking about evil pharma they talk about those that take old compounds and jack up the price. Not one mention in this documentary about small pharma companies struggling under the onerous and outdated regulatory environment. For instance Big pharma is avoiding being involved in making antibiotics for the the super bugs, because they have seen a small company that developed an FDA approved drug go bankrupt, they had incurred so much expense in going through the approval process, the market wasn't big enough for the drug to ever pay back what was put in. Result no new drugs for super bugs. Unlike what one of the people in the documentary has ignorantly said " there are no new drugs for cancer that work", there are new drugs and technologies for cancer. They are stuck in a regulatory nightmare, that takes so many years to get out to the public, it favors big pharma and crushes small pharma. Even a new form of radiation therapy which uses low yield isotopes, targeted molecularly to the cancer, where it destroys the cancer cells and leaves health cells untouched. This has been stuck in the regulatory process far more years than it should be, due to the onerous conditions put on them by the FDA. They can only allow candidates that are very old and it is basically their last hope to be admitted to the trial. People like trump crap on "drug companies" but without them you will not have new treatments period. Small companies need the government to clean up the mess in their governments regulators, if they can spend less on trials they can charge less for drugs. I know in a recent case, a moronic woman at the FDA, decided at the end of a trial she wanted to change the primary endpoints for a drug trial that cost them more the 50 million, and now they had to start another trial? You set endpoints of trials at the beginning of the trial! but this is of no concern to her, she still gets a paycheck from the FDA regardless of her incompetence. And trump wants lower drug prices? start by firing idiots like that at the FDA for a start.And like was mention in the documentary, change the way trials are done. Bureaucrats seem to live in a bubble thinking everyone else is the problem, pull out a few cases of abuse, but never talk about the abuse metered out by their regulators not having a care in the world about doing things to help the struggling phama companies.

  6. What has to change is people criminalizing an industry that saves lives. I think the price of gas is to high… Let's go FORCE them to lower the price. In my opinion, this documentary basically contradicts itself.

  7. Its comical that they are applying for patents to protect the price from going up? Why would the price be run up if you didnt have a patent… Thats called a generic drug and it decreases prices through increased competition. These doctors that want the data for free, are keeping that data protected? Nearly everyone is this doc is delusional… Not to mention that everyone of them continues to mention how expensive it is to do what they are trying to do… Why do I think they are reinventing the wheel just to end up becoming exactly what they despise… a pharmaceutical, for profit company.

  8. Hopefully one day the current poisoned industry will break; it is unbelievable that certain drugs are actually effective and people still dying as can't afford them.

  9. I was told I had real high sugar. My doctor prescribed meds. I decided to go natural and bought Berberine gold ,when I went back to the doctors. He said his pills are working good. Funny thing is I never took one.

  10. Decentralizing pharma? Use the blockchain technology in some way to conduct honest, anonymous research or something?

  11. MEXICO'S NEWLY ELECTED PRESIDENT ASKED THE PHARMACEUTICAL COMPANY'S TO SIT DOWN WITH THE NEW GOVERNMENT TO DISCUSS THE LOWERING OF THE PRICES OF MEDICATION'S BECAUSE DUE TO CORRUPTION THE PRICES ARE REALLY HIGH, THE PHARMACEUTICAL COMPANIES REFUSED TO DO SO, SO THE NEW PRESIDENT SAID F&&K YOU ILL BUY THEM SOMEWHERE ELSE WE ALREADY HAVE NEW SUPPLIERS, AND GUESS WHAT HAPPENED? :

    1) PHARMACEUTICAL COMPANIES BROUGHT THEIR MEDICATION'S PRICES DOWN 68%

    2) MEDICAL EQUIPMENT, ETC 48% LOWER

    THIS GOES TO SHOW THE OVERPRICING IS HUGE AND THAT IF YOU HAVE THE RIGHT REPRESENTATION TRU GOOD, CARING AND HONEST POLITICIAN'S CHANGES CAN BE MADE

    AND IT WAS ONLY POSIBLE BY CREATING A BRAND NEW PARTY, BECAUSE AS WELL AS IN THE USA THE EXISTING PARTIES WERE ALL PART OF ONE NEOLIBERAL SYSTEM, ITS ALL A FASAD TO MAKE US THINK WE HAVE VOTING OPTIONS WHEN IN REALITY IT IS THE SAME HOG ROLLED IN DIFFERENT MUD, THE DEMOCRATIC AND REPUBLICAN PARTIES ARE THE SAME SHIT, THEY ARE RUNNED BY THE SAME 1% ELITE OF FILTHY RICH PEOPLE WHO DON'T GIVE A FLYING F&$K ABOUT THE REGULAR JOE LIKE YOU AND ME !!!

  12. Its true ! Look at USA
    https://www.burzynskiclinic.com/ SEE HIS FIGHT FOR AMERICAN CANCER PATIENTS THERE IS A DOCUMENTARY ON HIM AS WELL !

  13. Please @vpro, push on the 'marketing side' of youtube and try to reach an higher visibilty of your videos! Such a high-quality content can't have just 15k views.

  14. Seriousness, scientific rigor and great personalities who attend your documentary, make it a piece of truth. Thank you for all whistleblowers who bring an invaluable corner stone to build up a new and way fairer pharmaceutical ecosystem. Thank you for posting this great doc. Keep it up!

  15. If politicians are that powerful, why do they often appear like Big Pharma's accomplices? Are they that easy to corrupt? Chilling. After decades of letting big pharmas do what they wanted, the society has reached a point of no return. The Shrekli's case in the US is Z signal that governments and consumers have lost permanently! WITHOUT A HUGE OVERHAUL of all the pharmaceutical ecosystem around the globe, it's hard to think how some balance between consumers and big pharmas could be reinstalled. I doubt seriously that a country like India would came to the table to discuss such a reform. We're doomed.

  16. why are these titled in english if they are going to be in duitch? like im no dictator , youll could do as you please , but this is misleading if not cclickbait

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