Read the Fine Print

They seem innocent enough, pads of paper around a display in the aisle at the mall promising a free chance to win the experience of a lifetime – a $59,900 sweepstakes. No purchase is necessary; just fill out the form. It must be very tempting because it looks like about an inch of forms has been torn off from each of six pads.

The forms ask for name, address, phone number, email, age, income, marital status and spouse’s name. That information was once considered somewhat private, but now people apparently are very willing to give it away for free for a chance to win about 60 grand. But they have a better chance to get something else, something much less desirable.

The bottom of the form under the signature line reads: “I consent to receive phone calls, including prerecorded messages and text messages from Promoters at the phone numbers/wireless numbers/addresses above regarding their offers, products and services, including through an automated dialing system.” That’s right, they are voluntarily signing up for the kind of irritating spam messages that everyone is complaining about and demanding action from Congress! They are giving permission to be pestered by robots about time-share opportunities!

Wow! All that personal information must be worth a lot more than $60,000 to the “Promoters.” (The other side of the sheet is filled with terms and conditions in very tiny font.)

Here’s another example. This comes at the end of a 4-page ad in a Sunday newspaper magazine section.

The ad is apparently for a clinic offering addiction recovery services including detoxification. (As soon as I saw reference to detox, I was skeptical; but it acts as a lure for others.)

At the very end of words and pictures showing how wonderful it is, at the very bottom of the page it begins with,  “The images herein are for illustration only.” The images are of happy people. Further on it says that the company “does not guarantee, warrant nor represent successful completion of its program for any of its clients. Results vary by individual, and [the] program may not be suited for everyone.” Then it goes on to say that they might not accept everyone in the program and gives some excuses about why the results for the ones accepted may vary. Finally, the company "is not responsible and expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on any information contained in this advertisement.” It directs readers to a website.

Basically, that translates into “maybe and maybe not.” After three-and-a-half pages of happy talk, this is something of a letdown. The company doesn’t promise anything. And they are very adamant about that non-promise. If a client goes through the program and does not get the results expected, it’s not the company’s fault. I would be willing to bet that the first requirement upon entering such a facility is to sign a page or two of documents acknowledging understanding of all their disclaimers.

Part of this song and dance about not being responsible may raise suspicions about the effectiveness of the treatment, but another part must be attributed to a typical reaction among Americans who are disappointed – blame someone else and take them to court. Nevertheless, reading the fine print and all the disclaimers before entering into any agreement leads to better decisions. If it looks too good to be true, guess what.

As the world gets more fast-paced and complex, it becomes of greater importance to pay attention to details. People trying to sell us things, whether it be services, products or ideas, have more tools to trap the unsuspecting and more lawyers to separate them from whatever consequences they may experience for their questionable decisions.

A Healthy Resolution Without Diet or Exercise

That’s right, to start the New Year off on the right foot, you don’t need to join a gym or shun the sweets. It seems that having perspective is good for you.

By way of review, perspective helps people see things as they really are, not as some exaggeration taken from social media or the news. It separates the important from the trivial. One of the easiest ways to exercise strong perspective is to have gratitude, to appreciate what we have instead of always yearning for more, nicknamed “the hedonic treadmill.” An important skill is to learn to make the right comparisons.

A recent NPR piece expounds upon the health advantages of such activities as keeping a gratitude journal. “There's a growing body of research on the benefits of gratitude. Studies have found that giving thanks and counting blessings can help people sleep better, lower stress and improve interpersonal relationships. Earlier this year, a study found that keeping a gratitude journal decreased materialism and bolstered generosity among adolescents.” 

There is also some evidence that it may lower the risk of heart disease and mitigate the symptoms of depression. [Links to all studies are provided in the NPR article.]

But it’s not necessary to keep a journal if some other reminder does the trick. Choose any daily routine or landmark along the commute to stimulate some thoughts about how lucky we are as Americans.

In her 2013 book The Myths of Happiness, Dr. Lyubomirsky, a recognized expert on the subject, agrees. Gratitude and appreciation, including appreciation for the others in our lives work toward “lending our lives greater meaning.” Her research suggests that “a new attitude toward money, time, spending and possessions can stimulate people to rise [above adversity] in ways that they previously had not envisioned, to contribute more positively to society, to thrive via cooperation and independence and to live more authentically and more lightly on the earth” (pp. 158-159).

 One trick to this appreciation is to make the right comparisons. Many Americans feel down or deprived by just looking around. Social media consistently portrays groups of friends having a wonderful time (while you sit at home). Stories are often of exceedingly glamorous or seriously miserable experiences, defying competition on both ends of the spectrum. The news media constantly scare the audience with isolated tragedies, without making comparisons or mentioning how rare they might be. (That’s not their job.) Other wrong comparisons include not being able to get your dream job or afford your dream house, dream vacation or dream car, or even keep up with the neighbors. (It’s nice to have a car with no payments that runs well and a house to keep warm and dry.)

What are the right comparisons?

The quote is sometimes attributed to the late George Burns, “When I get up in the morning I read the obituaries. If I don’t see my name there, I go to breakfast.” Older people find it easier to appreciate another day of life and the friends of today and the past. I was reminded recently that one hundred years ago instead of worrying about not getting enough likes on Facebook or stressing over the political shenanigans in Washington, Americans were concerned about their young men coming back from WWI alive or not dying from the worldwide Spanish flu pandemic, while they had a live expectancy 30 years shorter than today.

 If you are not one of the one-percent in the US, it’s easy to forget that the majority of Americans, anyone making over $32,400 a year, is in the top one-percent in the world (and people are risking their lives to come to this country).

But there are many less extreme reasons to be grateful in each of our lives, if we only take the time to find them (and write them down if necessary). 

A resolution to show gratitude, to improve behavior in the dimension of perspective, is free, painless, good for your health and good for society. (It may not be great for the economy, as people stop buying things they don’t need, but I’m not too worried about that.)

Do We Really Know Our Own Minds?

Well, except for the big-time procrastinators Christmas shopping season is about over. We have made our choices and spent what will probably again be a record amount of money on gifts, food and decorations. But recent stories in the news force me to wonder how Americans made those decisions, how they make buying decisions in general, and to ask the question: Do we really know our own minds?

The subject comes up after a few recent references to “influencers.” According to one business dictionary, influencers are individuals who have the power to affect purchase decisions of others because of their real or perceived authority, knowledge, position, or relationship. In consumer spending, members of a peer group or reference group may act as influencers.

They have power and they get that power because of their real or perceived knowledge or taste. But do they really deserve it? The only way they can get that power is because the ones whose decisions are affected have given that power to them. (I wrote not too long ago about the celebrity-endorsed sneakers selling for $999 with easy monthly payments – these are sneakers, not a car or a living room set!) 

We may listen to friends and neighbors to get some advice and learn from their experiences, but why do we listen to and follow the advice of sports stars or celebrities who don’t even know us? We let them make decisions for us and define what's cool. It must work because influencers are often paid to sway our opinions.

As this piece tells, there is more to the influencer phenomenon than meets the eye. In what the reporter refers to as a “bizarre and shadowy” industry, some companies feel they must pay influencers to speak positively about their products on social media. Despite the fact that “hundreds of thousands of dollars change hands daily” to buy these endorsements, many consumers trust these influencers as they would their friends and neighbors. The opinion of one experienced investor in a new start-up was that “to succeed, quality didn’t matter, nor did customer satisfaction—only influencers.”

It’s big business with the objective of making up your mind for you about what’s in, what’s out, what’s cool and what’s worth paying extra for. (One agency for influencers expects to make $20 million in deals this year.) And some influencers have been accused of buying followers to beef up the appearance of their popularity and raise their earning potential.

Surprisingly, there is some evidence that the influencers aren’t any better judges of fashion than the folks they try to influence.

A good example came from Payless shoe outlets, the discount retailer with stores in many malls. They teamed up with an advertising agency to make over a former Armani store in Los Angeles and fill it with Payless shoes, marking regular prices up by 10 times, rebranding the shoes with the designer-sounding name Palessi.

Next they “invited fashion influencers to get an exclusive first look at the new brand.” Some of these fashion experts “paid $200, $400, and even $600 for shoes that are normally sold for $19.99 to $39.99” 

In the first three hours they sold more than $3,000 worth of shoes. The company returned the money and let them keep the shoes, but will use the sincere and very complimentary comments in an upcoming advertising campaign.

So the question is: do we have the confidence to stop giving away our power, allowing others, who don’t know us and have little or no real expertise, to affect our decisions as consumers and citizens? Can we achieve a level of perspective to judge what is true and important instead of letting someone else do it for us? In short, can we stop acting like sheep, following the crowds as they follow the paid influencers, just trying to be cool or trendy?

Another question to consider: Unless we change this habitual behavior, how much easier do we make it for foreign powers or other nefarious actors to influence us using the same social media tools?

Dangers of Detox Plans

It began with the headline: “The Soy Sauce Colon Cleanse That Left a Woman Brain Dead Shows How Dangerous Viral Internet Trends Can Be.” Looking up “Soy Detox Hoax,” I found an interesting mix of news stories about this tragic event and other sites promoting the practice. On one hand there were serious warnings, but every other entry linked to what appeared to be “How To” information.

The Explore Health site called the practice an “extremely dangerous fad.” A 39-year-old woman tried the soy sauce cleanse and went into cardiac arrest on the way to the hospital. She was revived, but drifted in and out of consciousness for several days. She woke up with severe nerve damage, unable to move, swallow, or speak.

According to Fox News, who gave a similar description of the situation, tests showed extremely high levels of salt in her blood, which can draw water away from the brain.

This was not an isolated incident of a soy sauce overdose. Back in 2013, a 19-year-old man drank a quart of soy sauce on a dare. He began twitching and having seizures, then went into a coma and nearly died from an excess of salt in his body. Too much soy sauce is dangerous; a soy sauce cleanse is a bad idea.

But the problem is not limited to soy sauce. Another search, this time for “Dangers of Detox” yielded numerous articles in the mainstream press and on medical and health-oriented websites warning of the practice in general. They date back more than ten years. The danger is not really news!

Most begin by pointing out that the detox fads come and go, usually driven by one or another Hollywood personality. Here is just a sampling of reliable advice.

NBC News had a story back in May 2007, “Experts Warn of Detox Diet Dangers.” Their expert, a gastroenterologist, concludes: “Your body does a perfectly good job of getting rid of toxins on its own…There’s no evidence that these types of diets are necessary or helpful.” Another expert adds that any attempt to flush the bad stuff from your body, the so-called toxins, also flushes out “good bacteria that keep the intestines healthy.”

 From Live Science in November 2014: “There's no scientific evidence that juice cleanses are a sensible approach to better health.”

 In September 2013 a piece about hidden dangers of detox lists as possible side effects: vitamin deficiency, muscle deterioration, heart palpitations, hair loss, depression, abdominal and digestive pain, reduced immune system, skin problems, anemia, and gallstones. 

Harvard Health discussed it in May 2008. “We tend to forget that the body is equipped with a detoxification system of its own” and “can defend itself very well against most environmental insults and the effects of occasional indulgence.” If you're generally healthy, there is no need. If you are experiencing health problems, “visit your doctor instead of a detox spa.”

Journal of Family Practice in August 2011 published a rather technical document for its members about the dangers of colon cleansing. “Patients may look to colon cleansing as a way to ‘enhance their well-being,’ but in reality they may be doing themselves harm.” They emphasized that there are no proven benefits.

There you have it. Many sources tell the straight facts. Under normal circumstances, bodies are built to detox themselves. Colon cleansing or other detox programs or diets are not beneficial with a high probability of causing serious harm. Your body is not full of toxins. Your colon does not need to be periodically cleansed, and doing so does not support, strengthen or promote any natural processes.

With over 10 years of evidence, warnings and examples of cleansing gone wrong, why would anyone try it? One reason is that it appeals to those low on disciple and critical thinking, looking for easy answers and not necessarily fond of science. They trust Hollywood endorsements more than medical professionals.

Unfortunately, the ads and promotions are so easy to find. Mixed in with the numerous links to stories of the brain-dead woman were such headlines as “Best Colon Cleanses for 2018” and “Best Non-GMO Colon Cleanse,” which has a laughable account of a man who lived for over 150 years and fills the rest of the page with endorsements from satisfied customers.

Is It False Advertising?

A couple of years ago plaintiffs brought a class action suit against Boiron Inc., the maker Oscillococcinum, a homeopathic cold and flu remedy claiming that it didn't work. What was unusual in this case is that it went to a jury trial. Most of the time, in fact twice in the past in other lawsuits against Boiron, these types of cases are settled before they go to trial. Apparently this time the company decided it was time to take a stand and risk the decision of a jury. Surprisingly, the company won in court. The jury simply felt that the plaintiff hadn’t presented sufficient evidence that the product did not work as advertised, that is, they had not shown that it did not relieve flu symptoms.

 The reason this is coming to light now is that the plaintiff appealed to the 9^th Circuit, but the court sided with the company. The court found that “the jury appeared to have believed Boiron’s expert, clinical studies, and anecdotal evidence more than it believed the plaintiff’s expert." According to the court, there was no legal reason to overturn the verdict.

 But what exactly is going on here? Is there a scientific reason to doubt the claims of the company?

More can be learned from the website Rxlist.com. “Homeopathic products are extreme dilutions of some active ingredient. They are often so diluted that they don't contain any active medicine.” Due to legislation passed in the 1930s this type of product can be sold in the U.S. but, like dietary supplements, are not held to the same safety and effectiveness standards as approved drugs.

Oscillococcinum claims to relieve flu symptoms, but not cure the flu. It’s effectiveness is based primarily on self-reporting. The website finds “no reliable evidence that taking Oscillococcinum can prevent the flu and evidence of any beneficial effect at all is questionable “due to flaws in the study design.”

It is made by highly diluting in water a compound extracted from the heart and liver of the Muscovy duck. Its dilution rate is coded in homeopathic terms as 200C. This means there is one part duck in a solution containing 1-followed-by-400-zeros parts water. That is an insanely huge number. There isn't even a name for this number. It is more than the estimated number of molecules in the entire universe! It is physically impossible for any part of any active ingredient to survive that level of dilution. But homeopaths explain this away by saying that the water retains the essence of the ingredient (even though there is none left). The remaining water is then combined with inactive ingredients of lactose and sucrose.

“Most experts believe that it will have no beneficial effect and also no negative side effects.” How could it not be safe when it’s primarily sugar water, unless the sugar was somehow contaminated? The company relies on the placebo effect to influence customers and then uses endorsements and personal accounts in their advertising and in this court case.

In my opinion this is nothing but snake oil and that people are basically throwing money away. However, I agree with the jury and the court that they did not advertise falsely. People who are willing to pay about a dollar per dose and take three doses per day really believe in its power to reduce flu symptoms. That belief alone is often enough to make them think they feel better and to report a reduction of symptoms. (Note: Some people take it to prevent the flu, a benefit the manufacturer doesn’t even claim.)

 We each get to decide how to wisely spend our dollars. (Annual sales of Oscillococcinumin in the U.S. were $20 million in 2013, and they probably only had to use one duck!) Information on homeopathic medicines is so easy to find, but the ability to overcome most people’s longstanding beliefs is so difficult to sway.  And suppose those people who still have the flu, but strongly believe they feel better, decide to come to work or school and spread it around. What then?

Thoughts On Tipping

Interesting legal maneuvering has been going on in Michigan over something called the tip credit. It began with a ballot initiative that was challenged but upheld in court, but later was taken off the ballot after it was passed by the legislature instead.

Formerly, restaurants that employ servers, bartenders or delivery drivers were “obliged to pay those staff members only $3.52 an hour if the employees take in the rest of the minimum wage they’re due in tips.” Since the minimum wage was $9.25 per hour, if they received at least $5.73 an hour in tips, the restaurants did not owe them any further pay.

Under the new law, minimum wage would increase in annual increments to $12 an hour over the next three years, and the tip credit would be phased out. This is a big victory for labor advocacy groups, but the Michigan Restaurant Association (MRA) fears that it will drive up a full-service restaurant’s labor costs by 241% for their tipped employees. A survey of members by the MRA found that many restaurant owners plan to deal with this with a combination of cutting jobs and raising menu prices.

Despite the 30% increase from $9.25 to $12.00 per hour, it seems that the restaurant association could cope by adopting the European model where tipping is less common. Rick Steves, the travel guy, points out that “tipping in Europe isn't as automatic nor as generous as it is in the United States, and in many countries, they're not expected at all.” Often service is included in the bill, as it is in the US when serving large groups. According to this website, the default tip in the US should be 20%. Following this service-included philosophy, the restaurants could remain whole by gradually raising menu prices by only 10% and eliminating tips.

Note: A no-tipping policy would also eliminate a lot of intricate paperwork for the owners as the tip credit is phased out. It would also move the responsibility of training, rewarding and disciplining wait-staff from the customers to management where it belongs.

Surprisingly, the fear of this very thing, undermining the “existing tipping culture,” motivated many tipped workers in Michigan to organize a protest at the state capital earlier this year. They were very concerned that proposed changes would actually decrease their income. So those well meaning (out-or-state) labor advocates should have consulted with the Michigan restaurant workers that they were trying to protect before pressing for the changes.

One thing is for sure, when outside forces, either lawmakers or advocates or as in this case both, feel the need to tinker with an economic system; there will be unintended consequences. Enforced wage increases, unrelated to normal supply and demand, pushes up prices and may cost jobs. That’s economic understanding.

Side comment: For similar well meaning reasons, some people on social media have been speaking out against self-service checkouts at grocery stores, saying that they are taking away jobs. Last week my grocery store had signs posted at the self-service stations encouraging customers to apply for cashier jobs. Apparently with the current labor shortage, they can’t find enough cashiers and figure that people who have already been checking themselves out have acquired some of the skills needed!

Children Are Dying Of Parental Ignorance

I had just finished writing a closing comment last time about how science is often ignored in the courtroom. This is especially true in jury trials where each member of the jury arrives with individual prejudices and faulty beliefs. The following day I ran across two recent articles related to that subject.

The first was about an anti-vaccine activist who was hiring himself out as an expert witness in child abuse cases. As he testified about the case the prosecutor began questioning him about his other beliefs in an attempt to undermine his credibility.

Among the ideas he admitted to believing was that “Gavi, the Vaccine Alliance, a charity funded by the Bill and Melinda Gates Foundation to increase vaccination rates in poor countries, was committing genocide” by promoting vaccination of children. He also admitted believing that “Gavi – along with the World Health Organization, the Gates Foundation and UNICEF – were using vaccinations to force sterilization on people in third-world countries.” He likewise blames the rise in autism cases on the increased use of vaccines.

As justification he cited a 1972 report and a 1974 study “warning about the dangers of population growth” saying that it was “ ‘no leap of faith’ to believe that vaccination is being used to carry out this agenda.” But it is a huge leap of faith – in fact it is completely wrong and  unscientific to ignore the benefits of vaccination over the last century. Smallpox, diphtheria and polio, to name just a few, have been all but eliminated. The Centers for Disease Control and Prevention (CDC) states, “studies have shown that there is no link between receiving vaccines and developing ASD” (Autism Spectrum Disorder). The World Health Organization (WHO) agrees.

So his credibility should have been destroyed. Such a stance should be laughable to any educated, well-informed jury. But he has been called as an expert witness in over 80 child abuse cases, despite the fact that he trained as a radiologist, not a pediatrician.

I have posted a complete explanation of why the anti-vaccine activists are wrong, how it is based on faulty and fraudulent science, discussing the risks of such an idea. For a review of the evidence, see here from a year ago and here from 2015.

The second article was from the BBC reporting on the latest data about measles. They call it a devastating, “highly contagious disease that in severe cases can lead to complications such as blindness, pneumonia and infection and swelling of the brain.” WHO saw a 30% increase in cases in 2017 among children from the prior year, including 110,000 deaths. They expect the same for 2018. Some cases even arose in countries where it had been considered wiped out.

According to WHO experts, the primary reason behind this measles increase in developed countries has been that “vaccine hesitancy” is becoming more of a problem. "In some groups, this is driven by religious beliefs but in quite a few populations it is spread by false concerns about the safety of vaccines" often on social media where people like and re-post without any attempt to verify facts. A major challenge facing healthcare providers is how to counter such misinformation.

Many facets of this subject are scary: that superstitious people, led by some superstitious doctors and celebrities, promote this dangerous belief; that lawyers try to pass off as an expert witness someone who has not trained in the field and has demonstrably erroneous beliefs in closely related areas; and that the general public is blinded to scientific facts by social media misinformation. Anyone who really cares about child abuse should shudder at the death of 110,000 from a single preventable disease due to parents’ intentional or negligent inaction.

Don’t Just Shrug

So often, especially on TV, a news story can go flashing by so fast that we hear the main point and don’t pay much attention to the rest and don't think too much about implications. Before we know it, they've moved on.

Last week the news came out with such a story, that the FDA has approved an exciting new cancer drug. According to an NBC report: “While several drugs are approved to treat a variety of different cancers based on genetic mutations, Vitrakvi, known generically as larotrectinib, is the first that is approved from the beginning to treat cancers solely based on the mutation.” Instead of being approved to treat specific cancers that arise in certain parts of the body, Vitrakvi goes after the genetic characteristic of a cancer arising anywhere in the body. Although it doesn’t work for all types of cancer, this appears to be a significant breakthrough.

But there is a huge downside. In the sub-headline NBC mentions that the wholesale cost is expected to be $393,000 a year.

Another website discussed the cost in a little more detail. “The wholesale cost for the children's syrup is $11,000 for a month's supply and the oral capsules for adults wholesales for $32,000 per month. With insurance, most patients would pay $20 or less for a 30-day supply.” (This last comment is the part that I think would blow past most people causing them either to shrug or to decide that the downside was minimal.) 

But it’s not, and it should make everyone slow down and ask where that money to pay the difference, that is, $31, 980 per month, is coming from. Initially it comes from the insurance companies, but ultimately it would come from premium payers, you and me - either directly or indirectly when employers count the benefit costs as part of total compensation.

Assuming that the estimate is correct and that this drug could benefit up to 3000 people a year, that’s $90 million a year that has to come from somewhere. And neither the insurance companies nor Bayer, the manufacturer, is going to foot the bill out of the goodness of their hearts. The cost will be distributed. Everyone must understand that this is true for all drugs that are covered in part by insurance. As newer, better and more expensive drugs are developed to treat or cure a wider variety of diseases, that same pattern is followed every time. This is basic economic understanding; there is no magic money tree.

This is the kind of information that slides by when we shrug it off without thinking it through.

Side comments: 

Is there any irony in the fact that the same company that makes this new cancer drug also makes RoundUp, a substance many people believe causes cancer and that some lawyers are now advertising about to solicit clients?

How would a member of the if-you-can’t-pronounce-it-don’t-eat-it crowd react if the cure to their cancer turned out to be larotrectinib? 

In other words, why clutter the courtroom and the dinner table with real science when you can rely on misinformation and Internet memes for guidance?

Twenty-Three Months to Solve the Problem

Generally, I avoid topics that touch even indirectly on politics, but this subject has overtones of responsibility – doing something about a situation instead of trying to blame it on luck, circumstances or another person or group.

I get so tired of hearing about the supposed voter suppression because citizens have trouble identifying themselves at the polls. Now we are 23 months away from the next major election, and it’s time to do something about it instead of moaning or accusing after the fact, as has been the practice for many years. There is a better solution than fighting about whether or not the laws must be changed.

Spread the word. If anyone you know cannot for any reason obtain a photo identification, figure out what is necessary, take some time off from work or other interest and help them out. It probably only takes a couple of hours, depending on the efficiency of the local DMV. 

Another faster, but slightly more expensive option would be to help the person get a passport. Last time I renewed mine, I found a local pharmacy that takes passport pictures, and I spent less than an hour to drive there and leave with my photo. The rest can be done through the mail. (Some UPS locations also have this service.)

Every nursing home I’m familiar with runs a shuttle for these kinds of errands. People confined to their own homes must have someone to check on them periodically. Perhaps the same organizations that arrange for voters without transportation to get to the polls on Election Day could set up one or two ID days for those unable to make their own arrangements. With 700 days left to find a few hours to solve this problem for everyone we know, next time there should be no excuse!

As with so many other problems, we look to the government to fix it when a simple solution is within our reach.