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Healthcare marketing spent four years settling on one answer to the tracking problem. Get consent, log it and honor it. It rests on an assumption nobody checked, which is that a person is on the other side of the banner reading the question. Software answers that question now. AI browsers do the browsing for people, and when one meets a consent modal it clears the modal as an obstacle. The decision gets logged. Nobody made it. The record a health system would produce to show it honored patient choice is turning into a record of machine behavior. But patients were not reading the banner either. They clicked to make it go away. What changed is who is clicking, which raises a real question about what the consent ever documented. It gets worse at the portal. A patient can hand their own record to an AI tool, and the moment they do, the law protecting it stops applying. HIPAA gives them that right and does not let a provider refuse because the destination is unwise. A health system must complete a handoff it would be sued for making on its own. Marketing owns the door the agent arrives at, and inherits a problem it did not create and cannot fix with a banner. Underneath both sits a question about authority. No regulator drew this line. The federal guidance that set off the panic was vacated in court and never replaced, and the rule meant to succeed it keeps moving further out. The working standards came from settlements instead, which produce a price rather than a principle, and the patient whose information was disclosed collects about twenty dollars. Chris Boyer and Reed Smith work through whether calibrating to litigation risk is honest risk management or an industry declining to decide what right looks like. Jessica Holton, co-founder of Ours Privacy, brings the view from inside that constraint. She was buying media for a telehealth platform when the pixel guidance landed, pulled her tracking, and watched acquisition costs climb. Her argument is that privacy becomes an asset once the whole organization owns it. Her survey names the blind spot. Nearly everyone believes their stack is compliant, and a majority describe that same stack as pieced together. If software declined tracking on a patient's behalf this morning, your consent log recorded a decision nobody made. MENTIONS FROM THE SHOW Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Ours Privacy, the HIPAA-compliant customer data platform Jessica Holton co-founded, including the free web scanner she describes in the interview: https://oursprivacy.com/ Ours Privacy, $15M Series A announcement, August 2026. Founders Jessica Holton, Adam Putterman and Tyler Zey launched the platform in 2024 after running the telehealth company Ours: https://oursprivacy.com/blog/oursprivacy-series-a-announcement-growth-marketing-data-infrastructure-healthcare HHS Office for Civil Rights, guidance on the individual right of access, health apps and APIs. The source for the point that information sent to a third-party app at the patient's direction falls outside HIPAA: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access-right-health-apps-apis/index.html HIPAA Security Rule Notice of Proposed Rulemaking, published in the Federal Register January 6 2025 at 90 FR 898. Final action now listed in the OMB Unified Agenda under RIN 0945-AA22 HIPAA Journal on the delay of the Security Rule final rule, now pencilled for 2027, and the Privacy Rule final rule status: https://www.hipaajournal.com/final-rule-implementing-hipaa-security-rule-updates-edges-closer/ New York Attorney General settlement with NewYork-Presbyterian, December 2024, $300,000 plus corrective actions covering third-party online tools, pre-deployment testing and deletion of collected patient information: https://www.healthcareitnews.com/news/newyork-presbyterian-pays-300k-settle-ny-pixel-tracking-case Banner Health and LifeStance Health Group tracking technology settlements, including the Banner class of roughly 1,028,000 MyBanner portal users: https://www.hipaajournal.com/banner-health-lifestance-health-group-pixel-settlements/ Five healthcare providers settle pixel class actions, including Bayhealth Medical Center with a class period running through December 31 2025: https://www.hipaajournal.com/five-healthcare-providers-pixel-class-action-settlements/ Atrium Health $1.8 million pixel settlement, preliminary approval May 2026, covering MyAtriumHealth and MyCarolinas portal accounts: https://www.classaction.org/news/1.8m-atrium-health-pixel-settlement-ends-class-action-lawsuit-over-alleged-patient-data-tracking The effect of AI browsers on tracking and attribution, including Atlas auto-rejecting consent banners and stripping referrers: https://taggrs.io/ai-browsers-tracking-attribution/ Prompt injection in AI browsers, and the position from OpenAI and the UK National Cyber Security Centre that it likely cannot be fully solved: https://techjournal.org/are-ai-browsers-safe The GA4 consent change of June 15 2026, retiring Google Signals as a control and leaving ad_storage as the single gate to Google Ads: https://www.digitalapplied.com/blog/ga4-consent-split-june-15-2026-ad-storage-tracking-audit Jessica Holton on LinkedIn: https://www.linkedin.com/in/jessicalynneholton/  OursPrivacy: https://oursprivacy.com/  Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Learn more about your ad choices. 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Somewhere in every access center there is a drop-down menu. No answer. Left message. Refused. Not interested. Wrong number. The person choosing from it has the least context in the building and the most pressure on the clock, and the choice takes about four seconds. That code then leaves the work queue, enters a report and becomes the evidence for not spending on those patients again. Chris Boyer and Reed Smith open episode 504 by pulling apart two things health systems routinely treat as one. Capacity utilization measures whether you sold the inventory. It says nothing about who could not get in. Reed puts the distinction plainly. Capacity is the view from the provider's side of the desk and access is the view from the patient's. Marrying the two is the work. Then the evidence. A cluster randomized trial across 44 primary care practices and roughly 12,000 patients found that electronic health record reminders alone moved nothing at all. Completion of overdue follow-up ran 22.7% with reminders against 22.9% for usual care. Adding a letter and a phone call took it to 31%. Ordinary contact, twice, with no technology in it. Chris keeps the ceiling in front of the audience for the rest of the episode, because even in the strongest arm roughly two thirds of patients still did not complete. The second segment asks what a person is actually for. Medicare answered part of this in 2024 when it started paying for patient navigation, and the answer it gave is clinical severity, with a cancer diagnosis qualifying automatically. Patients owe 20% of the cost, which is one of the reasons practices report they have not started using the codes. Chris and Reed then sit with the finding that argues against them. In that same trial, adding a navigator on top of the letter and the phone call moved the number four tenths of one point. They work through what that does and does not prove, and land on three jobs a person can do that a letter cannot. Only one of them changes the system instead of recovering a patient, and it is the one nobody puts in a financial model. Jessica Walker of Care Sherpa closes the episode with the case. A health system handed her a list of oncology screening patients its access team had marked unreachable after the auto-dialer sequence ran out. What she found in that list was almost never disinterest. Wrong orders, wrong referring physician, wrong location. Phone numbers and addresses that no longer worked. Carrier blocking. Patients in hospice, deceased or no longer eligible while the order sat and expired. Patients who would have had to cross a river. Her description of it is that the health system was asking people to pick up a part-time job to fix their own referral. The most useful moment comes later. Her team heard the same thing from more than one patient, that the nearest location's hours did not work for a shift worker. The system added Wednesday evenings and recovered those patients. She also describes a referring physician who had quietly stopped sending patients because his patients were never getting their screenings done, and what it took to turn that back on. If you cannot say what your people do that a letter cannot, you have bought a service tier rather than an answer. Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Atlas SJ, Tosteson ANA, Burdick TE, et al. A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results: A Cluster Randomized Clinical Trial. JAMA. 2023;330(14):1348-1358. 44 practices, 11,980 patients: https://jamanetwork.com/journals/jama/fullarticle/2810508 Atlas SJ, Tosteson ANA, Burdick TE, et al. Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results. JAMA Netw Open. 2022;5(9):e2234194. Survey of 275 primary care practitioners across three health systems: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796828 CMS, Health Equity Services in the 2024 Physician Fee Schedule Final Rule. Principal Illness Navigation codes G0023 and G0024, plus the peer support codes, effective January 1 2024: https://www.cms.gov/files/document/mln9201074-health-equity-services-2024-physician-fee-schedule-final-rule.pdf-0 Pratt-Chapman ML. Navigation Refresh: Updates to Principal Illness Navigation Billing. Journal of Oncology Navigation & Survivorship. May 2026;17(3). Source for the 20% patient coinsurance as a reported barrier to adoption: https://www.jons-online.com/issues/2026/may-2026-vol-17-no-3/navigation-refresh-updates-to-principal-illness-navigation-billing Care Sherpa: https://caresherpa.com Jessica Walker on LinkedIn: https://www.linkedin.com/in/jessicawalkercaresherpa/ Eternal, the longevity startup founded by Alex Mather of The Athletic, which now generates a weekly AI audio recap of a user's own lab and wearable data. Fast Company, June 9 2026: https://www.fastcompany.com/91555441/eternal-startup-turns-health-data-into-ai-generated-podcasts TP488, "If Marketing Owned Patient Activation," referenced in segment one on marketing capturing demand and access dispositioning it TP482, "The Pilot That Never Graduates," referenced by Chris inside the interview when he asks Jessica how she broke out of perpetual pilot status The TPS Report newsletter, at touchpoint.health Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Recommendations from this episode: Chris: Earth, Wind & Fire (To Be Celestial vs. That's the Weight of the World), the Questlove documentary on HBO and HBO Max. Premiered at Tribeca June 3 2026 and released June 7 2026. 119 minutes. Covers Maurice White's jazz background and his plan for the band before it was a band: https://www.hbo.com/ Reed: the ETENWOLF P300 electric ball pump. Rechargeable, preset modes for basketball, football and soccer, custom PSI setting, inflates and deflates, ships with two needles and a pouch: https://etenwolf.com/collections/electric-ball-pump MENTIONS FROM THE SHOW Learn more about your ad choices. Visit megaphone.fm/adchoices

Healthcare marketing has had a caregiver persona for fifteen years. She was worried, researching options, wanting a second opinion. That was a fair description of the job in 2010. Today most family caregivers help with bathing, dressing and mobility, and many now handle injections, wound care, catheters and oxygen equipment at home. Eleven percent were trained for any of it. Chris Boyer and Reed Smith open on new research projecting how much bigger this population gets by 2040, and on why the explanation everyone reaches for turns out to be wrong. The rest of the first half is about why none of this reaches anyone's numbers. One caregiver arrives in a health system as three unlinked records. The one tool built to let her in goes unmarketed and almost unused, and the workaround hospital staff recommend instead would get a marketer fired. Then Chris turns to why every fix built for her quietly stops working around week three. Jessica Hulter and Lamarque Polvado of CareStarter built software that asked a clinic checkout desk for sixty seconds. Staff used it for two weeks, then stopped, and nobody could make them start again. What they did in response put the human somewhere other than where healthcare usually puts her, and Jessica is that human. If your organization has a caregiver persona, go find out what year the data underneath it came from. Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com The Future Availability of Family Caregivers: Implications for Late-Life Care Gaps, Population Research and Policy Review, volume 45, article 33, published online June 1 2026. Pairs the National Health and Aging Trends Study with kinship projections through 2040: https://link.springer.com/article/10.1007/s11113-026-10016-4 AARP Public Policy Institute, The Aging of the Baby Boom and the Growing Care Gap, 2013. Source of the caregiver support ratio, 6.6 in 1990, 7.2 in 2010, projected near 4 by 2030: https://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/baby-boom-and-the-growing-care-gap-insight-AARP-ppi-ltc.pdf AARP and the National Alliance for Caregiving, Caregiving in the US 2025. Fielded in 2024, published July 2025, 6,858 family caregivers on a nationally representative online survey: https://www.caregivingintheus.org/wp-content/uploads/2026/03/caregiving-in-us-2025.doi_.10.26419-2fppi.00373.001.pdf Security and Privacy Risks Associated With Adult Patient Portal Accounts in US Hospitals, JAMA Network Open, 2020. Survey of 102 US hospitals on proxy account availability: https://pubmed.ncbi.nlm.nih.gov/32364562/ Administrative burden as an organizational design problem, narrative review, The Healthcare Executive, August 2026. Source of the argument that burden work moves rather than disappears: https://www.thehealthcareexecutive.net/article/operations-quality-safety/administrative-burden-workflow-redesign-hospitals/ CareStarter: https://carestarter.co PIC6, the innovation unit: https://pic6.co PCSI, whose mission is to enhance the lives of people with disabilities: https://www.pcsi.org Jessica Hulter on LinkedIn, where she invited listeners to reach out directly: https://www.linkedin.com/in/jessica-hulter/ AFWERX, the Air Force innovation arm whose SBIR program funded the Travis Air Force Base work: https://afwerx.com/ Exceptional Family Member Program, Military OneSource overview: https://www.militaryonesource.mil/family-relationships/special-needs/exceptional-family-member-program/ GAO-18-348, DoD Should Improve Its Oversight of the Exceptional Family Member Program, May 2018: https://www.gao.gov/products/gao-18-348 Montclair Police Department cargo theft investigation, two pickups about an hour apart on August 17 at the Anheuser-Busch distribution center on Brooks Street in Montclair California, roughly $70,000 in product including about 40,000 pounds of Pabst Blue Ribbon. Pabst posted a reward and a return deadline on Instagram: https://ktla.com/news/california/40000-pounds-of-pabst-blue-ribbon-stolen-in-massive-california-beer-heist/ TP499, "The Experience Ends Where the Bill Begins," the Cassandra Skinner episode Chris calls back to on what looks like noncompliance TP482, "The Pilot That Never Graduates," the episode Chris calls back to on initiatives that never survive past the trial Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Recommendations from this episode: Chris: Ted Lasso season four on Apple TV+. Ten episodes, premiered August 5 2026 with new episodes weekly on Wednesdays through October 7. Jason Sudeikis, Hannah Waddingham, Juno Temple, Brett Goldstein and Brendan Hunt return, with Ted taking over AFC Richmond's second division women's team Reed: College football, and SEC Shorts, the weekly comedy sketch series on YouTube and Instagram that plays off the prior weekend's SEC results: https://www.youtube.com/@SECShorts MENTIONS FROM THE SHOW Learn more about your ad choices. Visit megaphone.fm/adchoices

Pew Research Center published the first clean count of how much of the internet is now written with AI. Roughly one page in ten shows significant signs of it. Filter to pages published since ChatGPT launched and it climbs past a third. Chris Boyer and Reed Smith spend the first half of the episode on what that measurement actually captures. Pew names four markers that have climbed since 2023: em dashes, Oxford commas, a vocabulary that includes delve, testament, tapestry and enhance, and the construction where a sentence tells you a thing is not just one thing but another. Chris walks through the tells Pew did not count, which turn out to be the more useful ones for anybody responsible for a website. The paragraph that ends by restating itself. Every paragraph running the same length. Content so generic it could belong to any health system in the country, because the model has no lived experience to draw on and never will. Reed pushes back in the direction the argument needs. Patients have been navigating vague human-written hospital pages for fifteen years. The model did not invent that problem. It removed the barrier holding the volume down, the way digital cameras ended the discipline of thirty-six exposures. Chris names where that leads: everything converging toward the middle, because averaging is how the models were built. The second half is for people who own content. Google Search Central says generative AI is useful for research and for adding structure to original content, and that using it to generate many pages without adding value may violate the scaled content abuse policy. Google publishes no threshold. No word count, no acceptable percentage, no safe number of pages. Chris and Reed get specific about where AI earns its place in content production and where it costs more than it saves, then land on the trap waiting at the end of it, which is teams running detection scores and editing toward a machine instead of toward a patient. Lacey Reichwald of AHA Media Group closes the episode with the finding that reframes the conversation. Content creation is the most popular use of AI in marketing departments and it is not where the efficiency lives. She has surveyed health system marketing teams for years, and her argument is that organizations keep backing a process into a tool rather than choosing a tool for a process. She also makes the case for putting the AI skeptics on the working group on purpose. If your content team is measured on pages published, you have already told them which of these two halves matters. Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Pew Research Center, How Much of the Internet Is Written With AI?, August 20 2026. Roughly 490,000 English-language pages from Common Crawl going back to 2021, scored with Open Pangram: https://www.pewresearch.org/data-labs/2026/08/20/how-much-of-the-internet-is-written-with-ai/ Google Search Central, Guidance on generative AI content, including the scaled content abuse spam policy introduced in the March 2024 spam update: https://developers.google.com/search/docs/fundamentals/using-gen-ai-content Google Search Central, Spam policies for Google web search, scaled content abuse definition: https://developers.google.com/search/docs/essentials/spam-policies Open Pangram, the open-weight detection model Pew used, from Pangram Labs: https://www.pangram.com/ LinkedIn "Seems like AI slop" reporting button, launched end of July 2026. Chief Product Officer Hari Srinivasan reported more than one million uses in the first weeks and roughly 40 percent fewer views on flagged posts: https://techcrunch.com/2026/07/30/linkedin-adds-a-button-to-report-ai-generated-slop/ Social Media Today, LinkedIn says 1M people have reported AI slop, August 20 2026: https://www.socialmediatoday.com/news/linkedin-says-1m-people-have-reported-ai-slop/828465/ Harvard Business Review, AI-Generated "Workslop" Is Destroying Productivity, September 2025. BetterUp Labs with the Stanford Social Media Lab, 1,150 full-time US desk workers. BetterUp is a commercial platform and the figures are self-reported: https://hbr.org/2025/09/ai-generated-workslop-is-destroying-productivity Harvard Business Review, June 2026 follow-on from Matthias Holweg and Thomas Davenport extending the argument into organizational knowledge decay AHA Media Group: https://ahamediagroup.com/ Lacey Reichwald on LinkedIn, where she publishes her tool tip newsletter: https://www.linkedin.com/in/laceyreichwald/ TP500, "Healthcare's Long Walk Toward the Patient," where the hosts describe AI drafts of the book getting smoother and less true at the same time Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Recommendations from this episode: Chris: Effin' Birds, the daily comic by Aaron Reynolds pairing Audubon-style bird illustrations with profane captions, plus the merchandise and playing card decks. Not family friendly: https://effinbirds.com/ Reed: Reacher, season four, on Prime Video. Eight episodes, premiered August 12 2026 with the first three, new episodes weekly on Wednesdays through September 16 MENTIONS FROM THE SHOW Learn more about your ad choices. Visit megaphone.fm/adchoices

When a channel gets regulated, the money does not disappear. It moves. And it has been moving a while now: pharma investment in out of home advertising rose more than sixfold between 2016 and 2024, according to OAAA figures shared with Fierce Pharma. The FDA is rewriting the rules on broadcast drug ads and has told drug sponsors that deceptive advertising has become the norm on social platforms. Billboards, meanwhile, are being sold to healthcare marketers as stable, trusted and brand safe. Chris Boyer and Reed Smith spend this episode on the question hiding inside that pitch. Is out of home actually safe, or is it just unexamined? Those are not the same thing, and only one of them lasts. What most marketing teams have not caught up to is what happened to the channel itself while nobody was watching it. A billboard can now be selected based on the health profile of the few blocks around it, using disease prevalence data mapped to inventory at a precision that would trigger a privacy review in any other channel your team buys. Reed calls it a data story wearing a billboard costume. Once you hear it that way, the brand safe framing starts to sound less like a description and more like a countdown. Then the conversation goes back to 1971, when cigarette ads were pushed off television and radio. The tobacco industry did not cut its budget. It relocated, immediately and measurably, into magazines and event sponsorship. Regulation eventually followed the money into those channels too, but the gap between the money arriving and the rules arriving was long enough to build an entire era of marketing on top of. Chris and Reed work out how long that gap might run this time. They do not land in the same place. The last stretch is for health system marketers specifically, who carry none of pharma's drug claims exposure and every temptation to copy pharma's response anyway. Chris and Reed close on concrete actions worth taking this quarter, starting with a question almost nobody has asked their media buyer, and a category of community partnership that does not look like advertising at all until you check what sits behind it. If your out of home campaigns skip the review your search and social campaigns already get, ask whether that is a judgment about the data or only about the format. Mentions from the Show: Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Fierce Pharma, 2026 forecast on pharma ad dollars shifting away from traditional TV, citing OAAA data on the sixfold rise in pharma OOH investment 2016 to 2024. OAAA is the OOH industry trade association: https://www.fiercepharma.com/marketing/2026-forecast-pharma-ad-dollars-will-continue-shifting-away-traditional-tv FDA, Launches Crackdown on Deceptive Drug Advertising, September 9 2025: https://www.fda.gov/news-events/press-announcements/fda-launches-crackdown-deceptive-drug-advertising OptimizeRx and Lamar Advertising partnership announcement, ZIP+4 mapping against Micro-Neighborhood Targeting disease prevalence data, September 9 2025. Vendor announcement, labeled as such: https://www.globenewswire.com/news-release/2025/09/09/3147336/0/en/OptimizeRx-Partners-with-Lamar-Advertising-to-Reach-Clinically-Relevant-Audiences-Through-Out-of-Home-Healthcare-Advertising.html Warner KE, Goldenhar LM, The cigarette advertising broadcast ban and magazine coverage of smoking and health, Journal of Public Health Policy, 1989: https://pubmed.ncbi.nlm.nih.gov/2715337/ Trends in Cigarette Marketing Expenditures 1975 to 2019, analysis of FTC Cigarette Reports, covering the post-1971 shift into unrestricted channels and the 1998 Master Settlement Agreement billboard and transit prohibition: https://pmc.ncbi.nlm.nih.gov/articles/PMC9048889/ World Out of Home Organization, Global Out of Home Expenditure Report 2026: https://www.worldooh.org/news/woo-global-ooh-expenditure-report-2026 OAAA, Out of Home Advertising Revenue Reaches Record $9.46 Billion, March 2026. Industry trade association: https://oaaa.org/news/out-of-home-advertising-revenue-reaches-record-9-46-billion/ Edelman Trust Barometer: https://www.edelman.com/trust/2026/trust-barometer TP472, "Reputation as a Signal, Not a Score," on declining institutional trust in healthcare TP429, "Are We Wasting Our Digital Media Spend?" on where healthcare media dollars actually go Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Recommendations from this episode: Chris: MuscleKit aluminum wall mounted anchor fitness system, 300 pound capacity, around $150 Reed: Nicpro 1.3mm mechanical pencil set, three pencils with black, red and yellow lead Learn more about your ad choices. Visit megaphone.fm/adchoices