I do think people are becoming more aware of the ads and ignore them. My CTR for flat stomach used to hover around and 6-7% years ago but has dropped significantly in the last couple of years. So immunity is probably a big part of that.
I only use AdBrite to manage a few flat rate ads on my site, but I did use their contextual ads for a short time and it worked OK. They don't seem to pay as much as AdSense, but I do like that you can approve or reject ads before they show on your pages.
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