Treating Symptoms

Driving around in the car listening to the radio the other day, I heard back-to-back public service announcements. 

The first was the sad story of the kid sitting in the corner of the playground without enough energy to play because he was hungry. It told me that one out of six kids in America is hungry and there is no reason for it. Donations would presumably help get food to the kid and solve the problem.

Someone at the station may not have been paying attention because the second PSA had the same theme, except this time it said that one out of five kids in America is hungry. I didn’t pay close enough attention to tell if this was a solicitation from the same charitable organization. I was too busy thinking about the underlying messages.

These PSAs actually led me to wonder about two questions. First, where did those seemingly iffy statistics come from? With about 74 million children in America, the difference between one in five and one in six is about 2.5 million kids. Are they hungry or not? But that’s just nitpicking.

The more important question is why are we only treating the symptoms? Hungry kids on the playground are the result of kids not being fed at home. Why are around 30 million families not feeding their kids? This is not a question anyone seems interested in answering – not these organizations and not the government. We just hear lamentations about how unfair it is that the food is not distributed more justly.

It’s hard to believe, especially at a time of full employment and help-wanted signs up everywhere, that all those families have just fallen on hard times. There must be a sizable percentage where people just plain didn’t acknowledge that it was an important enough consideration to be able to feed their kids before having them. In some cases she may have thought about how cute babies are and how having one would make her happier. In other cases he may have thought how cute she was and how getting her into bed would make him happier. When the consequences of those behaviors come calling, he may or may not even stick around and she can always look to the government to help bail her out.

Meanwhile the government has programs to feed the family while those other programs from the PSAs try to find ways to move the food around so the kid gets a good breakfast or a sandwich for lunch. Such systems are treating the kids almost as hostages. They are hungry and need to eat, so no one addresses the underlying issue of parental responsibility! Over and over we treat the symptoms and never dig any deeper to solve the core problem.

What’s worse is that by treating the symptoms, nothing was being done to discourage the same behavior by this generation or to discourage the same in the next. Whenever society decides to shelter people from consequences of their actions, they have less motivation to change, and others that observe this dynamic are less inclined to view those same decisions as problematic.  Of course, society can't let the kids go hungry and to confront irresponsible parents is branded as lacking compassion. Later everyone sits around wringing hands and wondering why the War on Poverty has not reduced the poverty rate after 50+ years in operation; but few understand why we will probably be hearing the same statistics 50 years from now unless something changes.

People, People, People...

And now back to one of my favorite topics, Americans being duped by celebrities or celebrity endorsements into buying things they don’t need, things of little value or things that are potentially dangerous. On an individual basis it’s sad, and on a societal one it’s very discouraging.

If your car broke down, would you have it towed to the local TV station for the news anchor to look at – even if his or her hobby happened to be car repair? Probably not.

If your toilet backed up would you invite the local golf pro over to fix it – even if he had an engineering degree and an interest in plumbing? I don’t think so.

If you had a health question, would you seek advice from a Hollywood star instead of a health professional? The answer should be the same, but then how does Gwyneth Paltrow get away with it?

She holds health summits for her Goop brand charging $1500 per person, “despite repeated debunkings of her brand’s health claims, and piece after piece arguing the nonsense she sells is nothing more than snake oil.” This article comments on a new partnership with Netflix to push her products. In addition to her original lifestyle-and-wellness business, she owns a clothing manufacturer, a beauty company, an advertising hub, a publishing house, a podcast producer and several others. According to the New York Times, her brand is worth $250 million!

By playing on her celebrity status, Ms. Paltrow is reeling in customers by the boatload pedaling what many sources refer to at pseudoscience and misinformation. Errors in fashion may be OK; customers risk nothing more than possible derision. But when it comes to someone’s health, outcomes can reach beyond a waste of time and money to become dangerous or even fatal. 

Take for example one of the ten most read entries on the Goop site. “In consultation with Dr. Alejandro Junger, we created a week-long detox menu to recover from post-holiday indulgence.” Likely no one ever looked up the doctor’s credentials or questioned the efficacy of his advice before venturing into this experiment in self-medication. Unfortunately, as I’ve often written before in detail, detox plans are both unnecessary and dangerous. 

In other examples related to health, Goop continues a war on science with claims that are so outlandish that the whole thing could be mistaken for satire. But it’s not, and it’s very problematic. Dr. Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, is a frequent critic. “Assuming this isn’t performance art, the increasing popularity of companies like Goop is a cause for legitimate concern. Despite the best efforts of journalists and doctors, the debunkers are not winning the wellness war. Indeed, there is evidence that the trust people place in traditional sources of science is eroding.”

 Or as Vox put it just last summer, “Goop has been called out for bullshit over and over. But the brand seems to be stronger than ever.” Many agree that such opposition has just strengthened the brand among those already made suspicious of traditional medicine by so many other snake oil enterprises – basically appealing to those people who have sent their critical thinking on a long vacation.

It’s ironic that science brings us smart phones and the Internet so celebrities can use them to profit from the ignorance of people by selling and/or endorsing junk-science treatments and fake cures. It demonstrates the truth of what Isaac Asimov said many years ago: “The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.”

Getting Smart About Your Health

A recent edition of the Consumer Health Digest in my email was a real eye-opener! It illustrated the primary reason for the need for consumer protection: many Americans are not using the slightest bit of critical thinking or scientific understanding when dealing with personal health issues. They are looking for magic answers and falling for the most outlandish promises with paper-thin backing.

The first article was about a New York University Psychology Department review looking for what they called “drift” from the core mission of social work. It asked: “Should social workers be engaged in these practices?” By systematically searching the Internet for practitioner websites, they identified many offerings that “fall beyond those fuzzy borders” of the defined mission and in fact, “might appear highly questionable.”

Looking at the accompanying table, there is no “might” about it. The long list includes such services as: a course in miracles, angel card reading, Aura-Soma®: Color and Aromas, Auricular Detox, Awakening Your Light Body and Radiance, Biofield Tuning, Certified Cuddle Party Facilitator and Certified Intuitive Healer. And those just brush the surface at the beginning of the alphabet!

These and many others on the list have the distinct color and aroma of pseudoscience, superstition and scams using mysterious-sounding methods to lure in customers. It leads to calls for a “concerted national effort to stamp out pseudoscience in all of healthcare.” But people are wasting their time and money of their own free will. We don’t need a national effort; we need a critical thinking population, because it doesn’t stop there.

Next I read about a former massage therapist explaining, “Why I quit my massage therapy career.” The author tells about disputes with his regulatory body and the hate mail from colleagues as he tried, through his writing, to call attention to all the unproven therapies passed off in that field of practice. He concludes, “Massage therapy has a deeply pseudoscientific character overall, defining itself mostly in opposition to science-based or 'mainstream' health care, where rejection of science is actually celebrated by many practitioners, probably a majority."

Again, the problem is not all the false cures, but that so many people fall for these deceptive practices with the hope that they have found the easy and magical way out of their various health problems.

Finally, in that same newsletter from that week: “The Federal Trade Commission (FTC) has announced that – as a result of a settlement – [the company] is mailing 227,995 refund checks totaling more than $6 million and averaging $26.57 to consumers who purchased health products from three individuals and the 19 companies they controlled—collectively known as Tarr, Inc.” Refunds included products for weight loss, muscle building and wrinkle-reduction. The company was accused of marketing their products with “unsupported claims, fake magazine and news sites, bogus celebrity endorsements, phony consumer testimonials, deceptive offers of 'free' and 'risk-free' trials, and enrollments of people without their consent in programs that charged them for additional products each month.”

But for every one the FTC catches, how many others slide by with similar schemes using endorsements in place of evidence, self-conducted so-called clinical trials, weasel words like “results may vary,” and the usual other tricks I warn of frequently? The only way to avoid these traps is to wise up, be skeptical and use critical thinking.

As an added note, not all the people that promote such treatments are charlatans. As I was training as a yoga teacher, I ran into a fair number of serious, devoted practitioners. They have a selective acceptance of science, where they want to pick and choose what to ignore and what counts as medicine, therapy and healthy practices depending on how their aura or chakras are aligned. Arguing the facts isn’t worth the time. (I’m sure many a shaman was equally sincere as he hurled virgins into the volcano.)

Lower Tax Refunds, Not Bad News

Despite what CBS and others tell us, the report from the IRS that “tax refunds are about $170 lower than last year” is not bad news. The fact that “the average refund so far this year is $1,865, down from $2,035 in 2018” is only a timing issue. People who think otherwise are forgetting how income taxes work.

Employers are required to withhold taxes from each paycheck. These are sent to the federal and state governments. It is better to have them withhold a little more to avoid being hit with penalties and interest for not paying enough up front. But traditionally, taxpayers have jacked up their withholding on each paycheck to ensure a large refund. It makes up for lacking the discipline to voluntarily put aside a little each pay period. 

At the beginning of each year they experience what seems to be a windfall. But it’s not some gift from Uncle Sam; it’s really just a matter of getting their own money back after it has been withheld from them throughout the year. Withholding and the refund are not separate, unrelated pieces. They are each part of the whole. Changes in one lead to changes in the other, but the total paid in taxes is exactly the same whether you get it today or next March.

Getting a smaller refund leads some to believe that the tax cut was not real. (See the CBS piece for examples.) But they have only themselves to blame. “According to payroll processing firm ADP, only a small fraction of workers bothered to change their withholding” as the IRS urged them to do after their employers adjusted their withholding. They were happy to get more in their paychecks, but want to complain later about a smaller refund.

If they looked at total taxes paid, it would be obvious. When someone else files the tax forms and people only sign at the bottom, it’s so easy to ignore the total tax and only care about the size of the refund check. 

Then the news media stir things up by airing the complaints and making a big deal of it while only explaining the details in the last part of the report (if at all). And Bloomberg predicts that Democrats will intentionally promote this misunderstanding to their political advantage. 

As one expert told CBS, "I think taxpayers generally will try to avoid thinking about taxes, even after a major overhaul." The story is the same with taxes, tax refunds and other related issues, such as Social Security and Medicare. Many Americans don’t want to take the time to understand the details. They just want to complain. The frightening part about democracy is that someone who doesn't pay attention has the same number of votes as someone who does.

Being Careful About What You Eat

It looks like a number of essays recently have been about food, but since I steer away from politics to show more everyday behavior, the healthy food stories tend to jump out. I found a number of fairly recent stories about whether being picky about our food is worth the effort. 

The marketing departments of food companies go out of their way to make us feel guilty about eating the wrong things and to reassure us that we are making wise food decisions. But how much is true and how much is hype?

Many packages are labeled as healthy. Does that have any real meaning? 

The FDA is in the process of redefining their guidance on this subject, updating it from the 2016 version that read in part: “this guidance is intended to advise food manufacturers of our intent to exercise enforcement discretion relative to foods that use the implied nutrient content claim 'healthy' on their labels which:

(1) Are not low in total fat, but have a fat profile makeup of predominantly mono and polyunsaturated fats; or
(2) contain at least ten percent of the Daily Value (DV) per reference amount customarily consumed (RACC) of potassium or vitamin D.”

They conclude “guidances describe our current thinking on a topic and should be viewed only as recommendations.” All that seems as clear as mud! So we keep seeing "healthy" on all sorts of packages.

What about organic? The government does have strict guidelines about what can be considered organic, but still there is no guarantee. As this article from last October shows: “Three Nebraska farmers will plead guilty to knowingly marketing non-organic corn and soybeans as certified organic as part of a lengthy, multi-million-dollar fraud scheme.” This had been going on for many years.

A few months earlier, this news came from the Genetic Literacy Project. “The U.S. Department of Agriculture fails at regulation of organic food as fraudulent products overwhelm the agency’s conflicted, compromised system.”

Furthermore, as I discussed in detail last May, the USDA organic program allows some pesticides not classified as synthetic, and tests only for those pesticides disallowed by the program. Organic pesticides are not necessarily safer and all products – organic or synthetic – have the potential to be toxic. The careful approach is not in the food supply but in food preparation, as in washing all fruit and vegetables thoroughly.

 The use of natural is even foggier.

The FDA has asked for pubic comment “on the use of this term in the labeling of human food products” as a result of three citizen petitions asking for a clear definition, another one asking that the term be prohibited on labels and several court cases requested clarification.

 It leaves us asking whether these terms are really helpful or just the usual advertising jargon. It shouldn’t surprise us when, just last month there was a nationwide recall of more than 68,000 pounds of “gluten free Organics Breaded Chicken Breast Nuggets.” But they sounded so healthy and natural!

It takes some critical thinking to get to the bottom of all this, but what is really called for here is a dose of perspective. There was a time when everyone didn’t worry so much about the credentials of their food. Many were just happy to have it. And that went for everything we put in our mouths. Consider the study a couple of years ago that cleaner surroundings were not necessarily healthier for infants, making them more prone to developing allergies. And books like Let Them Eat Dirt, warned about the dangers an over-sanitized world posed for children.

Yet advertisers find that these words, and others like green and sustainable, can have an almost hypnotic effect, causing consumers to turn off their critical thinking and just trust the labels.

More Reason to Ban Drug Ads

The last time I wrote a “Don’t Ask Your Doctor” piece was almost three years ago. It was a follow up to the original in November 2012. 

It seems clear that the many drug ads on TV and in magazines with the punch line “Ask your doctor if [fill-in-the-blank drug] is right for you” are merely an attempt by pharmaceutical companies to bypass doctors to increase sales by appealing directly to Americans with a demonstrated weakness in the area of discipline. The companies try to use the patients to put additional pressure on their doctors to prescribe expensive medications. It often interferes with the doctors’ ability to make a proper decision for fear of getting into an unnecessary battle with or ultimately losing a patient.

A common example of this patient pressure that I have run across in the past is the number of people who have gotten antibiotics from their doctors to fight a cold. Antibiotics are not effective for a cold, because it is a viral infection, not bacterial. Doctors know this. It is a waste of money for the patient and a danger to the rest of us as it promotes the evolution of stronger, more drug-resistant viruses.

I am not alone in my objection to these ads. The Washington Times points out that “only doctors have the training about, and knowledge of, such drugs, as well as insight into their patients’ medical backgrounds that may or may not be appropriate for such medications” and that the ads “contribute more confusion than useful information.” The US and New Zealand are the only countries in the world to allow this practice.

The American Medical Association has been calling for a ban on those ads for many years. Their position “reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices.”

And those marketing costs are high! From 1997, when it was first allowed, to 2016 “spending on medical marketing of drugs, disease awareness, health services, and laboratory testing nearly doubled, going from $17.7 billion to $29.9 billion.” The direct-to-consumer portion increased the most, both in amount and proportion of spending from $2.1 billion (11.9% of total spending) in 1997 to $9.6 billion (32.0%),” while the amount spent in journals directed at the doctors decreased.  That spending adds to the cost.

This is doubly important today when we have such strong evidence of how easily patients, and in this case parents, are influenced by misinformation and make such foolish decisions, pressuring their doctors about vaccinations. 

Here is a subject where the science is clear, while warnings and side effects are not buried in the fine print. It’s simple; measles can kill. Vaccinations work.

In 2015, California passed a law eliminating personal belief exemptions for vaccinations that kids must receive before they can attend public school. They can only get a medical exemption from a doctor. Fearful parents are pressuring doctors, causing this medical exemption category to increase by 250% over the first two years of implementation. Some doctors are even cashing in on this unwarranted fear by charging $300 to $500 to write recurring exemptions. The understanding about measles prevention is clear, but there has been an outbreak on the West Coast (and in Europe). These falsified exemptions and parental beliefs endanger not only the kids with fearful parents, but those who cannot be vaccinated due to valid medical exemptions.

This single example casts doubt on the FDA’s original argument for TV ads, that giving consumers more information would lead to better outcomes. It has more likely led to more unnecessary prescriptions and higher drug costs.

Another Look at Retirement

Last time I wrote about the inability of most Americans to cover a $1,000 emergency from their savings. What will they do when they decide to stop working?

This article from CBS puts it bluntly. “The vast majority of older working Americans don't have sufficient savings to retire full-time at age 65 with their pre-retirement standard of living.” Most haven't even been saving at the rate they should have been from the start and sixty percent of those between 55 and 64 are not participating in company retirement plans like a 401(k). The facts that people are living longer and social security is on shaky financial ground only compound the problem. The obvious solution is to dramatically reduce their standard of living, continue working or both.

Similarly this promotional piece from Merrill Lynch reports “most American Baby Boomers under-save [for retirement] by about 20%, but almost two-thirds believe they can retire with a comfortable lifestyle.” They over-estimate how much their contributions will increase in the future and under-estimate how long they will be living in retirement. Most don’t even consider the additional heath care costs that may not be covered by Medicare.

This warning is backed up by an opinion piece on the Bloomberg site. “Too Many Americans Will Never Be Able to Retire." The solution suggested by this author is to increase the number of babies and immigrants, hoping to develop enough workers to support the aging population.

The article argues that this situation where many Americans can no longer look forward to a comfortable retirement and must continue to work is blamed in part on the financial crisis, but the above survey report belies that idea.

On the plus side, some see as a positive trend that more and more older people are still working, “because it adds to the economy.” But others see it as a sign that many will never be able to retire at all.

So his main argument comes down to the problem that the fertility rate in the US “has fallen to 1.8 in 2016, implying long-term population shrinkage.” This will lead to “fewer young workers to support an increasing population of retirees” through Social Security and Medicare contributions. That's why we need cheaper housing, generous child-tax credits and universal pre-K education, in order to bring down the costs of having children. 

Unfortunately, there are a couple of serious flaws in this approach. First, a lower birth rate is characteristic of advanced economies. As the BBC reports: “There has been a remarkable global decline in the number of children women are having.” The global fertility rate has dropped from 4.7 in 1950 to 2.4 children per woman by 2017. Three factors contribute to this drop: fewer deaths in childhood, greater access to contraception, more women in school and working. It’s not just the US, and it’s unlikely that encouraging more children or more immigration will have any effect on a worldwide trend.

Second, the idea of having more children to help support the older generation seems strange. Why should we reward the negligent behavior of parents by placing extra burdens on their children – more Social Security contributions and more taxes to support those "needed" government programs? Within families, grandparents only want the best for their grandchildren, but inter-generationally, they seem to have no problem dumping the cost of their extravagance and their inability to plan onto everyone else's grandchildren.

Government Shutdown Hardships

A week ago CBS reported on IRS workers' problems that came from the shutdown. “After a month with no pay, real hardship does exist for IRS employees including not having the money needed to get back and forth to work or to pay for the child care necessary to return to work right now.” Even some cities have been struggling as spending and the related sales tax revenues decreased. There were many other reports from around the country about similar hardships: food, utility bills, transportation, credit card payments, rent, etc.

It’s sad to see about 800,000 Federal workers furloughed with no pay. Many were required to continue coming to work not knowing when they would next be paid. They would struggle until the dispute was settled and back pay arrived. I have no solution to propose to avoid shutdowns, but I know what should happen immediately upon the workers' return. All government workers should be given a class in personal finance.

Suze Orman is not the only one who has been advocating for many years that everyone have an emergency fund, but she gives familiar advice. Here from a 2015 article is a typical example. “Your long-term goal is to have eight months of living expenses set aside in your emergency fund. I know that’s a lot, but I want you and your loved ones to be okay if you were ever laid off, or sick for an extended period of time.” Other experts are more conservative, recommending 3 to 6 months. But still, that’s more than a few weeks.

Of course, no one has been listening. Unfortunately, government workers thrown into a panic, resorting to food banks after missing a single paycheck does not strike the public as unusual. An emergency fund of only $1000 would be a good start, but a Bankrate survey from 2018 showed “only 39 percent of survey respondents said they would be able to cover a $1,000 setback using their savings.” That leaves 61 percent of the entire population out in the cold – or going to a food bank – soon after losing a job.

Admittedly, losing their job is not usually on the minds of government workers. Their job security is enviable. However, there have been four shutdowns in the last six years, each with the potential to cause similar problems. Between that and the same chances of personal emergencies that they share with the rest of the population – auto accidents, illnesses, personal injuries, etc. – their lives overall are not that much different or more secure than the rest of us.

Critical thinking dictates a need to build an emergency fund. Discipline is required to stop living paycheck to paycheck in order to do that. Responsibility implies that hardships after only a month without pay gives them no right to play the victim. That status, however, is too convenient for politicians trying to shame the other side, trying to shift the focus away from their own inability to act like competent leaders or even like adults.

This is yet another crisis that can be laid at the feet of individual behavior. The news media has this same information, but don't expect them to report it that way. They are too busy pushing sob stories and manipulating our emotions to keep the ratings up, to ask what personal choices could have allowed those crises to be averted.