British Columbia bans mandatory high heels at work


I’m sure there will be mixed comments on this, but it makes sense for several reasons:

  • Safety
  • Comfort
  • Productivity
  • Gender equity

As noted in a previous blog, US emergency rooms treated an average of more than 12,000 injuries each year between 2002 and 2012, and the trend is increasing. (1)

Health insurance costs being what they are, how does requiring employees to wear heels make any sense?

So, one Canadian province has taken action. (2) The government of British Columbia has stipulated that employers can no longer require high heels as part of a work dress code.

Very intelligent.  No wonder people live longer in Canada.

This discussion calls to mind a classic issue that has arisen in relation to motor cycle helmets, seat belts, physical fitness, impaired driving, and vaccines — an individual’s actions affect others.

What do you do when one person’s choice can raise health insurance costs for everyone else? Each person who pursues a risky behavior adds a small increment to the costs borne by health insurers, and the little pieces add up. Of course, the health insurer response is to raise rates to cover these costs. Everyone who has insurance pays more. 

US public policy in this area is at best erratic. Some rules support individual liberty; some what is best for the majority. Very inconsistent.


  1. Mary Elizabeth Dallas, “Injuries from high heels on the rise,” Spectrum Health Healthbeat, 13 JUne, 2015.
  2. Jamie Feldman, “New Canadian Law Bans Mandatory High Heels At Work,” Huffington Post, 10 April 2017.

Just how smart are you with your money?


The Future is coming, whether you like it or not. In fact, some parts are going to be very ben_franklinpositive, and some aren’t. You have to be prepared to deal with both. The sooner you start to prepare, the lower your costs will be!

We like to think about buying a house, buying a car, fancy weddings, babies and graduations. We don’t like to think about down payments, maternity costs or paying for college. However, as economist Milton Friedman famously wrote, “there’s no such thing as a free lunch.”

The statistics are simple.

  • The average life expectancy (LE) in the US is 78.8 years (1) — shorter for the poor and Southerners; longer for women and the affluent.
  • The healthy life expectancy (HLE) in the US is 68.1 years. By comparison, the HLE for Bosnia is 68.8 years and for Canada it’s 72.3 years. (3) HLE in the US varies by state and is shorter for Southerners. (2)
  • The difference between LE and HLE is the amount of time you can expect to have to deal with some kind of physical impairment. In the US, that amounts to a decade of trouble on average.

A new study confirms what people with elder parents already knew: older people need help with daily living. Even if they are fairly independent, both finances and medications can get out of control. They may not have or want to be dependent on family members to manage either.

Over 10 years, 10.3% of those aged 65 to 69 needed help managing medications and 23.1% needed help managing finances. These rates rose with age, to 38.2% and 69%, respectively, in those over age 85. Women had a higher risk than men, especially with advancing age. Additional factors linked with an increased risk for both outcomes included a history of stroke, low cognitive functioning, and difficulty with activities of daily living. (4/5)

There are resources, but they aren’t free.

  • The average cost of in-home healthcare in the US is $3,600 per month, as I mentioned in a prior blog. The average cost of a nursing home is $9,200 per month. Medicare can pick up the first 100 days. One of the Trump proposals for Medicaid reform involves eliminating Medicaid as a way to deal with these expenses.
  • There is a  category of professional, “daily money managers.” These aren’t financial planners, but they deal with records management, budgeting, checking the validity of expenditures, and bill payment. Costs for these services vary but can start at around $450 per month. (6) Not only do they keep things together for their clients, they are an important line of defense against scammers preying on seniors.

So, how are your parents going to deal with this? How are you going to deal with this when it’s your turn?

These problems are  best addressed when you do what most people don’t — act early on them.

  • Set aside dedicated savings for retirement.
  • Purchase permanent life insurance with a rider that allows you to take up to 50% of the face value of the policy for disability and long term care expenses. (7)

Both of these actions are best done earlier in life rather than later

  • Starting savings early allows the most time for compounding of interest.
  • Starting life insurance early minimizes cost. Insurance premiums are directly related to the length of time the carrier expects to have your money before they have to pay out. The earlier you buy, the less it will cost and the more you can afford. For example —
    • In NJ, for a woman age 24 non-smoker, a new $200,000 whole life policy might cost $113.68 per month.
    • In NJ, for a woman age 44 non-smoker, the same policy would cost $365.08 per month.
    • In NJ, for a woman age 59 non-smoker, a new $100,000 policy would cost $395.08. From the carrier used to quote these examples, a $200,000 whole life policy would not be available for someone that age.

With age, the price goes up and what you can buy goes down.

Procrastination costs you money. Don’t put this off.

If you practice a healthy life style, you can try to minimize the gap between LE and HLE, but you can’t count on eliminating it. There are just too many factors outside of your control (e.g., ice, drunk drivers, pollution, etc.).



  1. Centers for Disease Control and Prevention, “FastStats,” 17 March 2017.
  2. Centers for Disease Control and Prevention, “State-Specific Healthy Life Expectancy at Age 65 Years — United States, 2007–2009,” 19 July 2013.
  3. World Health Organization, “Healthy Life Expectancy at Birth — 2000 to 2015,”
  4. Nienke Bleijenberg, Alexander K. Smith, Sei J. Lee, Irena Stijacic Cenzer, John W. Boscardin, Kenneth E. Covinsky. Difficulty Managing Medications and Finances in Older Adults: A 10-year Cohort Study. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14819
  5. Wiley. “Many older adults will need help with managing their medicines and money.” ScienceDaily. ScienceDaily, 7 April 2017. <
  6. For those in the NJ area, I have a friend, Nancy Sobin, who offers these services. Please see her at She belongs to the American Association of Daily Money Managers,
  7. There are some companies that offer these riders for term insurance, which is much less expensive than permanent. The problem is that term insurance typically terminates by age 65, and home or nursing home care expenses typically start after that age. There’s no point having a rider that’s not going to be in force when you need it.

Environmental Causes of Illness


The battle about whether environmental pollution causes cancer seems to mirror the long fight to establish acceptance of the link between cigarettes and lung cancer.   It wasn’t accepted  until we had documentation of the specific mechanics of cell transformation into cancer. Even with that documentation, there remain a few skeptics.

A new study from Lehigh university links birth defects and low birth weight babies to emissions from coal-powered power plants. The plant in question is now partially closed and has been converted to run on other fuels. However, the emissions from that plant appear to have injured newborns in four NJ counties. That is another demonstration of the broad reach of pollution from a single plant.

This raises an interesting quandary. Can one be pro-life and pro-coal?


  1. Muzhe Yang et. al. “The Impact of Prenatal Exposure to Power Plant Emissions on Birth Weight: Evidence from a Pennsylvania Power Plant Located Upwind of New Jersey,” Journal of Policy Analysis and Management, 4 April 2017, DOI: 10.1002/pam.21989.

More on Strep Throat


This isn’t Halloween, and this story isn’t funny.  Here’s the short version:strepthroat_456px

  • Father contracts step throat in early March.
  • Family is tested for strep.
  • Six-year old daughter has bacteria even though she has shown no symptoms, and is given a ten-day course of antibiotics.
  • Daughter starts exhibiting flu-like symptoms on March 25th, and is misdiagnosed has having Influenza A.
  • On March 27th, she has pain and swelling on left leg, and is rushed to Arkon Children’s Hospital. She is now diagnosed with necrotizing fasciitis, commonly referred to as flesh-eating bacteria.
  • Her leg is amputated below the knee.

Strep throat normally affects the tonsils and throat. The cause is Streptococcus bacteria. If the bacteria enters the bloodstream, it can then cause necrotizing fasciitis, which is life threatening.

What the CDC says about how you get strep:

Strep throat is an infection in the throat and tonsils caused by group A Streptococcusbacteria (called “group A strep”). Group A strep bacteria can also live in a person’s nose and throat without causing illness. The bacteria are spread through contact with droplets after an infected person coughs or sneezes. If you touch your mouth, nose, or eyes after touching something that has these droplets on it, you may become ill. If you drink from the same glass or eat from the same plate as a sick person, you could also become ill. It is also possible to get strep throat from touching sores on the skin caused by group A strep. (2)

This is the third published report in recent weeks about amputations related to strep.

What you need to consider:

  • Strep bacteria can live in the nose for weeks without symptoms. It’s possible that a saline nasal spray may help reduce the risk of infection or ease symptoms once infection starts.
  • If someone in your family gets it, everyone needs to be tested. Same for the workplace.
  • Don’t expose others to strep unnecessarily. Stay home from work or school.


  1. Brian Zimmerman, “6-year-old loses leg after complication from strep throat,” Becker’s Infection Control and Clinical Quality, 5 April 2017.
  2. Centers for Disease Control and Prevention, “Worried your sore throat may be strep?”
  3. eMedicine Health, “Strep Throat: Home Treatment.”

Photo courtesy CDC website.

Diagnostic Errors


Facts to consider:

  • 10% of initial medical diagnoses are wrong and contribute to between 40,000 and 80,000 deaths in the US each year. That’s comparable to annual deaths from breast cancer. (2)
  • According to a study by Johns Hopkins, 13% of stoke victims on their initial visit to an ER are sent home without proper diagnosis or treatment. (1)

What you need to consider:

  • Every patient needs an advocate, especially if the patient is unable to express his or her concerns.
  • Doctors are human and humans make mistakes. If the doctor’s diagnosis doesn’t feel right, push back.
  • If it’s important, get a second opinion from an independent medical professional.


  1. Merrill Goozner, “Editorial: Diagnosing Wisely,” Modern Medicine, 25 September 2015 (republished, 6 April 2017).
  2. Society to Improve Diagnosis in Medicine.

A vaccine for colon cancer?!


Thomas Jefferson University Hospital is on a roll.  Wow.

This time it’s immunotherapy for colon cancer. As the ACS notes, this is only one of several improvements in cancer treatment now in the works.  However, it might be a particularly important one.

A drug developed by researchers at the Hospital is about to enter Phase II clinical trials. Here’s the story:

After identifying the Guanylate Cyclase C enzyme in the early 1990s, Scott Waldman, MD, and Adam Snook, MD, are set to take a vaccine that targets the enzyme to destroy metastatic tumors to a phase II trial in 2017.

Here’s what you should know.

1. Dr. Waldman and Dr. Snook are both professors at Thomas Jefferson University in Philadelphia, and Dr. Waldman is the chair of the department of pharmacology and experimental therapeutics.

They reported the enzyme has been “shown to be highly accurate for detecting the spread and predicting recurrence of colorectal cancer.” The duo’s vaccine instructs the immune system to stop metastatic tumor cells and destroy them.

2. Dr. Waldman said the preliminary findings on the vaccine “mean we have the potential to limit the aggressive nature of this disease and prevent metastases.”

3. Exton, Pa.-based Targeted Diagnostics & Therapeutics holds the rights to the drug and has supported the work in Dr. Waldman’s lab.

4. After 15 years of research and several lab and animal-based studies, Dr. Waldman’s new drug application was approved by the FDA in 2013. His phase I trial tested the safety and tolerability of the drug in stage I and II cancer patients. It was safe and well-tolerated.

5. Dr. Waldman recently secured funding for a phase II trial. It’s set to take place in 2017, pending FDA approval. It will assess the vaccine’s effectiveness with intent of commercializing the vaccine. The trial will take two years.

6. If the trial can show efficacy, the physicians will seek Orphan Drug Status to “fast-track” it to the market.

In short, the drug identifies colon cancer cells to the body’s immune system for attack. The Phase I trial established that the drug itself would do no immediate harm to the patient. Phase II will assess how effective it is.

What you should consider:

  • IF the drug works as it appears to, trials like this can be lifesavers for patients with advanced colon cancer. 
  • Do you know someone who might want to participate in the trial?


  1. Eric Oliver, “Metastatic tumor-destroying vaccine for colon cancer patients to begin phase II trial: 6 key notes,” Becker’s GI and Endoscopy, original date, 16 November 2016, (re)published 4 April 2017.
  2. Viral Gene, Inc., “Viral Gene Announces Breakthrough in Colon Cancer: New Vaccine Targets Enzyme to Help Destroy Metastatic Tumor Cells,” press release, 22 November 2017.
  3. American Cancer Society, “What’s new in colorectal cancer research?” 1 March 2017.

Unnecessary stents?


Thomas Jefferson University Hospital comes through again.

Do you really want a surgery you don’t need?

Coronary artery disease (CAD) is the most common form of heart disease in the US, and hd-coronary-adkills over 370,000 Americans each year. It involves a blockage in an artery carrying blood to the heart and can cause damage to the heart muscle and death.

The common form of treatment for a blocked coronary artery is a balloon angioplasty, and procedure that uses an endoscope to move a balloon to the blockage and inflate it, increasing the width of the artery and allowing blood to flow. The procedure may include placement of a stent to keep the artery open permanently. It’s a simple procedure and fairly common.

There are risks to the procedure, and about 3.3% of patients die. Risks include blood clots that can originate at the site of the blockage and travel to organs or the brain.

Oddly, while heart disease can occur anywhere in the US, it is most common in the Southheart_disease_deaths.png and lower Midwest, in states including Kentucky, Alabama, Mississippi, Arkansas, Louisiana and Oklahoma. What people eat in this region may put them at particular risk.

Doctors at Jefferson have found that some doctors mistake “coronary spasms” for CAD. The Jefferson team routinely treat patients with nitroglycerin prior to placing a stent, and noticed that for some patients, the nitroglycerin was sufficient to solve the patient’s medical issues.  The stent was unnecessary.

Their conclusion is that some angioplasties may be unnecessary.

According to Michael Savage, M.D., Director of the Jefferson Angioplasty Center and senior author of the report:

“Interventional cardiologists [cardio surgeons] should be especially suspicious of coronary artery spasm when they encounter a patient under the age of 60 with disease isolated to a single vessel. We recommend that future guidelines include intracoronary nitroglycerin for these patients.” (5)

However, nitroglycerin is not now part of treatment guidelines.  Thus the concern that some people are being put through surgeries that are of no value to them, and incur unnecessary cost and risk.

The surgery is of no value for artery spasms, as these can easily recur at a different place in an artery after the stent is installed.


  1. US Centers for Disease Control and Prevention, “Coronary Artery Disease (CAD).”
  2. US Centers for Disease Control and Prevention, “Heart Disease facts.”
  3. Steve Sternberg and Geoff Dougherty, “Angioplasty: Risks and Benefits,” US News, 11 February 2015.
  4. Vishnevsky, A., et al. Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines. Catheterization and Cardiovascular Interventions, March 2017 DOI: 10.1002/ccd.27034
  5. Thomas Jefferson University. “A simple fix to avoid unnecessary coronary stents is overlooked by cardiologists and current cardiovascular guidelines.” ScienceDaily. ScienceDaily, 20 March 2017. <>.