Naked Medicine

Let's Face It: Medicine is Business

Do Mylan shareholders want the CEO to keep raising the price of the EpiPen?

Do Mylan shareholders want the CEO to keep raising the price of the EpiPen? We don’t know yet.

Investors like a company to deliver positive earning results and increased guidance, and the recent negative public opinion has given investors a reason to sell, which was what happened. Currently $MYL is in “oversold” territory.

Mylan 1 year and 5 year trends:
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Keep in mind that 68% of Mylan is institutionally owned. Thus the market makers’ decisions will determine whether “shareholders” truly want the CEO to keep raising prices of the EpiPen. Retail (individual) investors’ outrage makes little difference to $MYL stock price, unless you happen to be an individual who owns millions of shares of $MYL.

I suspect that there is a sweet spot that is not being discussed, which is, the institutional investors want to ensure that the EpiPen continues to dominate the market (which is temporarily the case, given the set backs of potential major competitors) but also not be priced to the point where backlash from the reimbursement side triggers costly events.

If $600 is too much for public opinion to stomach, what about $500? $400? It’s not so much about what the “real” price ends up being on the consumer-side, but the publicity around the price itself, as well as the defense of the price by a CEO who hasn’t been successful pitching the coupon/assistance angle. That’s about as effective as a U.S. private university saying, “Sure, our tuition is $65,000 a year, but our students almost never pay full price!!!”

SOMEONE is absorbing the escalating cost of a life-saving product, and we’ve been around the block long enough to know that at the end of the convoluted cost justification conveyor belt, we consumers will end up getting bitten on the butt.

Entities investing in businesses can claim an interest in public good, but only based on the extent that the cost/risks from actual (lawsuits, sanctions, blacklists) or perceived (bad PR) harm not exceed the revenues earned from pushing-moral-envelope decisions.

Once that risk begins to overshadow the rewards, you will see major shareholders send a message by selling $MYL shares. Then we can say for sure whether shareholders want the CEO to keep raising prices. Even Turing and Valeant had their glory days of astronomical stock prices, so you can’t say that shareholders aren’t enamored by questionable business practices, at least in the short term.

It’s all about risk:reward.

Update 8/29/2016

Within a week of the public outrage, Mylan will Launch Cheaper Generic EpiPen Alternative. Sounds like a good response, until you consider the fact that Mylan’s ability to launch this generic version in “several weeks after labeling revisions” means Mylan has always had within its capacity to offer a more affordable product (keep in mind, the generic version is still a 300% price hike from the original $100 tag). When was Mylan ever going public with this generic?

Also in question is 1) the growing public awareness of the CEO’s 600%+ hike in compensation that is being linked to the company’s pricing “strategy” and 2) less public awareness of the CEO selling 100,2000 shares of company stock at $50/share for a gross $5,010,000 after the earnings report, but before the price hike frenzy (SEC FORM 4). You can’t convince me that any executive shrewd enough to get to a C-level position can’t foresee the possible public backlash to a 600% price hike of a cheap drug delivered in the medical device that is really the main “product”.

The fact that Mylan did this in response to negative publicity reinforces the public perception that the pharmaceutical industry does indeed have “affordable alternatives” but chooses to withhold them to the public to rake in more profits. Even though reality is what Bruce Booth wrote in Forbes (Innovators vs Exploiters: Drug Pricing And The Future Of Pharmaforbes.com), where differential pricing exists for the industry to offset the steep discounts in other countries by making “countries that can pay”, pay much, much more.

The average consumer is not going to care to understand the complex pharma industry supply chain or convoluted regulatory maneuvers. The consumer knows that healthcare is at a tipping point that somehow hasn’t been tipping in the right direction, and industries like pharma spending a lot of money lobbying and advertising. More and more, social media is enabling consumers to coalesce into groups and transform into activist voices that can change how companies make decisions.

This means the pharmaceutical industry should start paying attention to actually educating consumers on the brutal realities of opaque drug pricing versus perennially showcasing the bloating belly of “cost of discovering and bringing drugs to market.” Let’s face it, that argument has not convinced the public on why drugs cost so much, and it’s a failed strategy. The industry needs to spend money on what actually works to engage consumers, not on new versions of the same graphs that had thus far convinced few and far between.

Theranos’ AACC Presentation: Not the Reboot We Were Hoping For

Move over, Edison: here comes miniLab.

And yet: “Every piece of technology they presented has been known for many years, and exists in other platforms largely in the same configuration, or in some cases in much more compact form in competitor’s platforms.” ~ associate professor in U. Washington’s dept of laboratory medicine.

Data has not been independently verified.

Holmes did not clarify that the 11 tests she presented would require at least 3-4 pricks if each prick yields only 160-uL amounts.

http://www.wsj.com/articles/theranos-founder-elizabeth-holmes-introduces-new-blood-testing-device-1470089582

Theranos Had a Chance to Clear Its Name. Instead, It Tried to Pivot

Killing Zika Virus Carrying Mosquitoes with Gene Drives?

Genetically engineering out the lives of pests is not a new idea. The idea of leveraging sexual reproduction to pass specific gene changes (mutations or alterations) through entire populations to control pests has been proposed as far back as the 1940s, for example, A Strain of the Mosquito Aedes aegypti Selected for Susceptibility to the Avian Malaria Parasite Plasmodium lophurae.

Evolutionary geneticist Austin Burt was credited with the method of cutting DNA to reduce populations of disease-spreading species and the associated idea of “Gene drives”. The central idea behind a gene drive is to ensure that the engineered module stands a high probability of being passed onto offspring, such that the genetic module can be spread through the population. We can “drive” a genetic mutation into an entire population.

“How do we do this?”

Imagine if we can genetically engineer the virulence out of mosquito bites — nay, let’s engineer the future lives out of an entire species of the worst offenders (these would be the aegypti mosquitoes) — and free our communities of chemical pesticides! Kill the pests but spare our environment!

That is what Oxitec is working on. The company is harnessing a pathway that has been explored for killing cancer cells to genetically engineer male aegypti mosquitoes. Male aegypti mosquitoes live long enough to mate with female aegypti mosquitoes in the wild. Males pass along what amounts to a ticking time bomb genetic sequence to their female partners. Their offspring will then carry these gene sequences that produce death-causing proteins.

Female aegypti mosquitoes are the ones that bite and deposit diseases in hosts. Thus rather than working on fatality-causing mutations where an aegypti mosquito embryo won’t even see the light of day, Oxitec wants the males mosquitoes to mate with the existing biting wild female population. Offsprings will die before adulthood due to the inherited vulnerability or will be too weak to survive the normal assaults of nature.

“Should we do this? How far should we do this?”

Along with questions of possibility and feasibility comes questions of ethics and responsibility.

What are the ethics of genetically extinguishing entire species, even if we’re talking about a loathed species like the aegypti mosquitoes? You will hear bioethicists talk about the impact on the natural food web and the ripple effect of employing such technology (i.e. “Today, mosquitoes. Tomorrow, other species maybe even certain humans?”)

Additionally, one can argue that the very situations fertile for cultivating diseases are not fixed by genetically fixing pests. How does genetically engineering mosquitoes fix the slums and ghettos in which pests and disease carrying insects establish and thrive? How do we know that another species won’t take the place of one that we genetically extinguished, because the very conditions of poverty remain?

Questions about genetically engineering away virulence and pestilence are complex, and reach beyond what is merely scientifically possible.

We need to consider the law of unintended consequences, and these are complex questions of consequences that are difficult for us to imagine, until we’ve done it.

Then, do we do it? Should we do it?

Transgender, Cisgender: Where does gender identity come from?

“What causes a person to be transgender”? You might as well ask the question, “What causes a person to be (a) gender?” These questions ask the exact same thing.

If you are a cisgender person wanting to understand what causes a person to be transgender, then ask yourself, “What causes me to identify as the gender I am?” The answer goes to the heart of the gender “identity” — what makes a person know “the gender” that person is and what makes a person cisgender or transgender, comes from the same “root”.

For a cisgender person, the answer may be easy: look down and you have your answer. But this answer does not tell the whole story. We look down because this is the easiest way for cisgender people to get an answer, and since our self-identification is congruent with our observation, we don’t further question. But what if our self-identification is not congruent with our observation?

Then let’s examine this “root” or “roots”. In other words, What is the origin of gender identity?

We know from empirical evidence that “biology” with its “male” and “female” hormones, do not dictate gender identity. There are biological males and females who identify with the other gender. Along with biology, is the genetics and epigenetics consideration: perhaps a set of genes contribute in whole or in part a “gender identity”. Genetics determine gender from a biochemical perspective, but I don’t know of any evidence that suggests genetics determine “gender identity”.

Biology and attendant hormones do not “cause” gender identity, even though hormones certainly shape the gender experience.

Cordelia Fine’s book, Delusions of Gender describes copious evidence that gender identity is socially reinforced. The book shows how even the most conscientious parents who want to raise their children “gender neutral” are not immune to reinforcing gender biases. Delusions of Gender is persuasive in arguing that society drives the parameters of gender conformity but does not examine the origin of “gender identity”.

Social and cultural rules do not dictate gender identity, even though society and culture drive conformity of gender behaviors.

What about psychological and neurological factors? Cisgender people do not deal with psychological or neurological issues around their gender identity, because “gender identity” is not even a thought — it is a knowing that is reinforced by and congruent with their biological and social/cultural experiences. Psychological and neurological considerations arise primarily when a person’s gender identity do not align with biological sex, and even then, are considerations imposed by others (people who decide that “something is wrong”).

I don’t view psychology and neurology as determinants of gender identity, even though both are used as factors when society impose “rights and wrongs” about gender identity.

Now I am left with a phenomenological dimension as the origin of gender identity. The very origin of your conscious knowing that “you” are “you” is also the origin of your gender identity.

In other words, strip away physical properties (Homo sapiens) and social conditioning (gender) and cultural constructs (role) of what and who you are.

How do you still know “who” you are?

That which creates the conscious quality you self-identity as “Me”, gives rise to your “gender identity”.

This conscious quality, within which gender identity resides, emerges independently of biology, society, and culture.

Just as this conscious quality that lets you self-identify as “Me”, emerges independently of biology, society, and culture.

What we are seeing as “gender identity” are really products of biology, society, and culture ACTING UPON the original conscious quality, and assigning a moral value to a phenomenon.

When there is agreement between gender identity and biological/social/culture influences, we don’t think twice about “gender identity” even as we may debate on the frameworks that society and culture have on “gender roles/rules”.

When there is disagreement between gender identity and biological/social/culture influences, we have heated arguments about the “right or wrong” about gender identity, when the real “rights or wrongs” remain with the frameworks that society and culture have on “gender roles/rules”.

Gender Identity is part of Consciousness.

How Antibiotics Work

Antibiotics work according to the mechanism of action (what the drug “targets” in microbes or how the drug “works” in the microbe) that is driven by the drug’s distinguishing chemical structure.

Chemical structures also define the “classification” of antibiotics. If you hear doctors talk about “macrolides” versus “quinolones”, they are talking about families of drugs (not “one” specific drug) and they are referring to the way each family of drugs targets microbes.

When you hear about “generations” of an antibiotic, this means the chemical structure of the current drug has been modified (changed) somehow. These changes are designed to improve the action of the drug, especially when the bacteria have evolved to resist the original drug.

A well known example is Penicillin resistance. Overuse of penicillin resulted in widespread bacterial resistance to this drug. If I went to the doctor today and the doctor decided that a beta-lactam based antibiotic was appropriate, the doctor may prescribe amoxicillin or one of the newer generation cephalosporins versus the original penicillin. That’s because the doctor is thinking the bacteria in my body will probably laugh at penicillin and a “newer” penicillin (like amoxicillin) may be needed.

Why We must complete the ENTIRE course of antibiotic therapy

One of the biggest problems in antibiotic resistance, besides antibiotics being over-prescribed, is patients stopping their medication as soon as they start feeling better instead of finishing their entire course (taking ALL pills prescribed by the doctor).

Imagine your body is a kingdom and your immune system as a fortress/defense system. Your kingdom has undergone an invasion. Taking antibiotics is similar to giving your immune system a much needed weapon to defeat the invaders.

A full course of antibiotic therapy aims to kill off as many invaders that have infiltrated your kingdom within as short amount of time as possible, so that your defense system can take care of the rest, and to ensure that ALL the invaders are killed.

People sometimes stop taking the antibiotic when they start feeling better (“Oh, I’m already feeling better”) or for another reason (“hey, maybe I should save these couple of pills, just in case, for next time”). The problem is that there may be a few invaders that have thus far evaded the antibiotic response, and these will be the invaders who will come back with a vengeance, literally.

Your feeling better has do to with most of the invaders being killed off, but the few that have escaped being killed are buying time to adapt and evolve… to become smarter against your defenses.

Antibiotic resistance arises from the ones that have been allowed to escape because the host (you) decided “All is well, call off the troops!” and giving the invaders time to learn how to better take you down the next time there is an opportunity.

Based on the way each antibiotic family targets microbes, the drugs in that antibiotic family may either kill (bactericidal) or stall the growth of (bacteriostatic) microbes.

This is where we get into the specifics of “how” an antibiotic works. Antibiotics aim to kill by:

  • Targeting a specific feature of bacteria
  • Targeting the reproductive process of bacteria
  • Targeting a critical chemical pathway in bacteria (especially protein synthesis)
  • Overcoming bacteria’s evolved mechanisms of resistance (for example, bacteria that have evolved pumps in their membranes to “pump out” drugs)

Targeting a Specific Feature of Bacteria, Reproduction, or critical process (typically making proteins or “protein synthesis)

Antibiotics that target gram positive bacteria will disrupt the chemical process critical to making the thick peptidoglycan wall (the thick wall is what holds the “gram stain” that allows us to visually identify the “gram positive” bacterial strain).

However, if the bacteria has a thin peptidoglycan wall (this then won’t show up as bright violet stains on the gram stain, making this bacteria a “gram negative” type), then an antibiotic that targets that wall won’t do much damage.

Instead, you’d need an antibiotic that targets a specific feature of gram negative bacteria or target a critical process like protein synthesis. For example, the antibiotic can cross the gram negative bacteria’s cell wall (but are blocked by gram positive bacteria’s peptidoglycan layer) to stop protein synthesis, which stops many critical machinery in bacteria.

Antibiotics that target the bacterial reproduction prevents new bacteria from being produced. This gives your body a fighting chance to go over the existing microbes.

Theranos’ Elizabeth Holmes is Not a Liar

(Via Quora’s Is Elizabeth Holmes a liar?)

The Theranos story has gone from bad to worse, first from the Wall Street Journal “expose” that Holmes during a live blogging event equated to “tabloid” journalism, then from a series of very public disengagements with partner corporations, and now — complying with a Herculean FDA request. This is causing some in the public to ask whether Holmes is a mastermind in a fairytale of scientific triumph.

No. Holmes is not a liar.

Holmes made bad business decisions and painted herself into a corner.

Holmes is in the class of executives that are technologist founders, which combines subject matter STEM expertise with the vision and strategy typical of C-level executives. The challenge with this class of executives is that they often do not excel in all aspects required in each role. There are incredible business chiefs that cannot do the job of their company’s top subject matter experts (SME). There are genius technologists who can rapidly run businesses of any size to the ground. It is rare to combine both SME and business acumen at the highest levels in one person.

In the case of Theranos, she was extremely effective in the beginning, when she needed to create excitement and inspire others to support her vision. She fulfilled an important role for a chief executive. She brought the technology into development, which fulfilled an important role for a technical subject matter expert, although I am less “sold” on how cutting edge her technology is given the lack of data, thus I hold her less credible on the SME role compared with the CEO role.

Companies must exist beyond initial honeymoons, and especially must weather and survive crises that are part of business cycle/life. Add to this, the “healthcare business”, where we now involve the quality and quantity of people’s lives, and we can see the level of shit-storms that can happen. In the healthcare business, I have come to believe that the question is never about “if” a shit-storm will happen to a life science company, but “when” and “how bad” a shit-storm will happen.

This is where Holmes began making a series of bad calls that snowballed into bad decisions, which became bad publicity that she made worse by more bad decisions. Now we’re at the point where we may want to believe but we harbor more doubt because of Holmes’ cumulative actions resulting from the original points of doubt.

But has Holmes fared worse in her CEO actions than other CEOs who have been embroiled in scandals? Has she behaved in a way that shows greater opacity or concealment than other CEOs under fire from public scrutiny?

I don’t think so. Holmes is acting exactly as other CEOs had to act in this situation: as directed by company lawyers, to ensure her actions are in the best interest of Theranos at this point. Even if she was the one who caused great harm the credibility and public image of the venture that has become her entire identity.

The Theranos Problem in One WSJ Graphic

Now that Theranos is allegedly/denying-trying to raise money, speculations continue as to whether it could survive the Wall Street Journal article, Hot Startup Theranos Has Struggled With Its Blood-Test Technology, or whether a big industry player may swoop down to acquire the company.

In terms of “who would be audacious (to use a polite word) enough to possibly merge/acquire Theranos”, I think a diagnostic company would be more a likely candidate… you know, one of the big players that Theranos was meant to “disrupt” the business of.

The short sighted assumption from many people thus far, is that Theranos was the only company that had the “foresight” to reduce sample volume required for blood based assays.

Can we actually believe that NONE of the big players NEVER considered the competitive advantage of reducing sample volume required from patients and human subjects? Are we saying that all these years no one had ever realized how many people hated needles, and the kind market leadership position one may gain if one creates an assay method that enables accurate sampling of mere drops of blood versus vials of blood?

When we look at Theranos’s “accuracy” compared with hospital results, most scientists familiar with the assay process can deduce the magnitude of what needs disrupting:

The best performance in the graphic from Theranos in terms of “accuracy” compared with a hospital result “standard”, is the glucose test.

This is nothing to be impressed about: getting the glucose reading right is no newer than the finger prick glucose draw available from today’s diabetes management devices. It only shows Theranos got their tech as right as what is already available in terms of a finger prick blood sugar test.

Perhaps someone can use current glucose monitoring technology, modify it so it could assay for Herpes (simplex type1), and see if the same “tech” transfers readily to accurately test for Herpes. This would offer an interesting data point to show just how novel the “Edison portfolio of technology” is.

This one graphic sums up the Theranos problem: the most accurate comparison is in a variable for which cheap and accessible diagnostic is available (glucose), and not for any variables for which wide clinical use are expected (liver function tests, which are critical for a variety of medications affecting liver function).

Theranos’s results are consistently “false positive” compared with hospital standard: if a clinician believes in the Theranos result, the clinician may order the patient to stop taking medications that the patient needed and was doing well on, but should no longer be taking because the results show that liver was being negatively affected, or the clinician could switch to another less effective medication for the patient out of concern for liver function. Either case, if the Theranos test was inaccurate, this would cause harm to the patient by unnecessarily disrupting treatment regimen that was otherwise appropriate.

This is not the kind of “disruption” healthcare providers want.

From a business perspective, Theranos’s FDA approved use for its product has a very narrow indication (Herpes), yet the test is commercially available without authorization from a licensed healthcare practitioner. This is great for the company’s bottom line, because the (federal) agency will have a tough time identifying which kits have been purchased for “approved” use and which kits are actually used “off-label”. The pricing advantage allows Theranos to reduce dependence on CMS reimbursement, by going straight to consumers. Liability becomes a matter of personal injury, which may be skirted when the consumers assume entire risk by “inappropriately using” the kit.

However, this is not great from a consumer protection standpoint.

We may subscribe to a conspiracy theory about major diagnostic and device companies colluding to keep an oligopoly on expensive assay machines and profit margins for assay kits, but from a business competition standpoint, the market dominance/leadership would be too attractive for a major player to ignore in the name of market oligopoly.

Biotechnology Stock Price Drivers

The following may be happening that can affect the stock price:

  • Presentations or buzz occurring at key scientific and medical meetings; for oncology from which many biotechs sprout, we have ASCO, ASH, AACR, to name a few key meetings.
  • Clinical trial results are closely pending or just released. Typically companies dealing with the same or similar technology/pathway are affected by a peer company’s clinical trial results.
  • FDA decisions pending or released.
  • FDA holds on a clinical trial either imposed or lifted (as with $GERN).
  • Management taking the “poison pill” strategy against possible hostile bids (as with $ARIA 2 years ago)
  • Earnings are reported (usually at a loss unless there is already a commercial drug).
  • Merger & acquisition activity (Drama around $VRX hostile bid for $AGN).
  • Licensing announced including upfront/milestone payments.
  • Orphan drug designation announced (as with $ISIS recently).
  • Key management (C-level for biotech) changes.
  • Major insider buys/sells (like when $INO’s CEO bought a ton of company stock as a show of confidence when stock dropped last year because a blogger made unfavorable comments about the company’s drug, or $OPK’s founder buying a ton of his company’s stock last year when $IBB went through a bloodbath.)
  • Major shareholder (usually investment firms or hedge fund managers) buys/sells.

For the most part, biotech stocks should be viewed either as a speculative investment and/or truly for the long term. Those who bought $MDVN or $PCYC when these were in double digit prices and held through 2015 has seen their investment double or triple in value. There are those who daytrade and really speculate the sector for its volatility, but that’s a pretty stressful “day job” in my personal opinion.

What You Need to Know about Your 401K Plan

Before entering your employer’s 401K plan, you need to decide:

  • Percent of pre-tax contributions
  • Percent of post-tax contributions
  • Percent of employer match

At the very minimum you want to contribute whatever % your employer matches, this way you can get the $ that your employer sets aside for your 401K.

Preferably you will maximize % of pre- and post-tax contributions regardless of employer match.

Percent of pre-tax contributions are useful for reducing your AGI (adjusted gross income). Percent of post-tax contributions are useful for building up your retirement nest egg in a way that is automated (out of sight, out of mind, therefore out of impulsive spending if you have those habits).

The only time when you may consider reducing (never eliminating!) your pre-tax contributions is when you have a significant loan term that has a less favorable % return than if you take that percent of your paycheck to pay down the loan. Even then, calculate carefully whether your investment returns in your 401K may fare better. Example: you have a mortgage loan at 6%. You may calculate the probability that you’d do better paying this down sooner versus building up a nest egg 401K that compounds interest over time.

Part of the investment election process includes:

  • Choice of funds
  • Expense ratios (cost)
  • Redemption fees
  • Your investment plan or strategy

Employers often offer both passive index (mutual) funds AND actively managed funds. Employees are able to choose what products they want their contribution to go toward.

Basically the options are in broad categories of “Bonds, Stocks/equities, and Target Retirement”.

Bond funds are just that — made of bond products, although you’d want to look at what are actually in those bond products. Sometimes these include treasury (US dollars) and other mortgage backed securities, some of these riskier than others.

Stock funds are made up of all or selection of stocks in the stock market that is supposed to represent “the market”.

Target retirement funds tend to be actively managed (more expensive) but is promoted as “you don’t have to do anything, we’ll do it for you” products. These are sometimes called Life cycle fund or similar name. It’s supposed to shift the allocation of lower-risk (usually bonds & cash) versus higher-risk (usually stocks) products as you age, so that you won’t be exposed to too much risk as you near retirement age. I don’t buy these since I can click buttons and enter % of allocation for bonds:stocks based on risk tolerance and overall retirement portfolio (important if the household has dual working partners so you are dealing with 2 retirement portfolios not one).

My rule is to ALWAYS GO FOR PASSIVE INDICES. In other words, products that are a version of “S&P500 index”, “Total stock market index”, “Total bond market index”, “Total international stock market index”, and “Russell 2000 index”. This is because the cost of owning these (expense ratio) makes a huge difference over time as you leverage compounding interest, without paying the 401K management company a higher cost to buy other funds. In 401K these actively managed funds tend to be ‘sector based’, such as ‘healthcare’ or ‘technology’. I ignore those, since I can buy sector mutual or ETF funds for way cheaper at Vanguard’s retirement account.

‘s an example of a Russell 2000 index fund expense ratio (cost) at a major employer’s 401K fund selection:

Same employer’s sector-based (science/tech) actively managed fund:

Granted, the “Morning Star” boxes are not identical because the science/tech fund is more Large Cap-Growth (big companies) while Russell 2000 focuses on smaller companies (high risk and high reward Small Cap-Blend), but if you want to focus on big companies then you might as well go for the total stock market index fund (cheaper Large Cap-Blend) which costs:

Finally, investment strategy is based on where you want your money contributed when it is automatically entered into your 401K account, and how often you want to move your money based on market conditions (although you will never move it while incurring any redemption/short-term trading) fees. Moving money isn’t taking it out (distribution — a No-No) — it’s simply transferring monies in a particular fund into another particular fund to match your (“household”/family) overall portfolio’s target asset allocation.

For example, if the S&P index fund has done well but is looking over priced, I will move all/a percent of money out of this into another fund that is pulling back (looks cheaper). Usually I have enough time to plan because I can’t move money between accounts without incurring redemption fees, so I may start watching a particular index that appears to be heading to lower prices and wait until I can “sell high” (fund that’s doing well and moving money out of” to “buy low” (fund that’s cheaper).

Disclaimer: Not a CPA, not a Financial Advisor, Not affiliated with FINRA. Just an individual who has taken time to educate myself on money management and I usually read Prospectus(es).

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