Naked Medicine

Let's Face It: Medicine is Business

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).

What to Do If You Lose Your Wallet

Some time ago, I lost my wallet, and within the hour that I realized my wallet had been lost, I was able to do the most important “damage control” tasks like:

  • notifying credit card companies to cancel existing cards and issue new card numbers
  • downloading a duplicate health insurance card
  • figure out how to replace driver license
  • putting a “freeze” on opening new lines of credit

Other than knowing an exciting day of waiting at the DMV (Department of Motor Vehicles) is in my future, I am glad I haven’t lost anything I cannot replace.

Since my credit card transactions all come with email alerts, if anyone had tried to buy anything with the cards, I’d be notified immediately via email.

In terms of lines of credit being opened, this is where putting a “credit freeze” is critical. In the U.S. the 3 major credit reporting agencies will get a record “pull” anytime when anyone inquires about your credit or someone (hopefully yourself) is trying to open up a line of credit: maybe this is applying for a new credit card, or apply for a store card, trying to buy a car, trying to inquire about a mortgage or line of equity loan etc…. by putting on a “freeze” it forces the inquirer to call a number before any data can be pulled. This way you will know if someone is trying to use your identity and take a loan in your name.

The “credit freeze” is new for me this time around when I lost my wallet, but I’m not actually worried about my credit cards being used in appropriately because of the email alerts and also because I acted extremely quickly, and have online access to all my credit card transactions.

While it’s very disturbing to have lost my wallet — I forget to appreciate how much having a method of identification factors into daily financial transactions — I also appreciate how technology lets me minimize financial damage in a quick and timely manner. Of course I’m still hoping a kind-hearted person will turn in my wallet to the police and I have filed a police report.

Do you have a “lost wallet” action plan?

Value of Money

Depending on situation, money buys:

  • stability
  • security
  • choices
  • freedom
  • influence

I am under no delusion that most of what I enjoy today in my life: stability, security, choices (to work or not to work, to do certain types of work, to work only certain hours), and freedom (being able to immigrate and stay in this country) were supported by a level of financial means.

Read some personal accounts on Quora of why people have to go to “cash advance” gouge-level interest services or why they have to line up to renew food stamps, and I appreciate all the more how “money-supported stability” makes the difference between maintaining life in the middle class versus becoming a member of the working poor.

Thus, I can’t in my good conscience talk down money like I’m holier than needing a currency. All the other stuff like bartering and in-kind services are simply other currencies that “money” represents as the de-facto symbol.

Antibiotic Resistance: Cultural Issue not Medical Science

We must tackle a cultural problem around overuse of antibiotics.

It doesn’t matter whether we keep coming up with antibiotics: we simply breed for the most drug resistant pathogens by increasing the selective pressure in bacteria. We do this by over-prescribing antibiotics.

But wait. This isn’t necessarily about getting doctors to stop over-prescribing antibiotics. If it were that simple….

When a patient comes in complaining of what a physician judge to be “a cold”, the physician may very well tell the patient, “Go home, sip lots of hot tea and chicken soup, get plenty of rest, and take some decongestant for the symptoms.”

Then that patient says, “But I waited in your damn office for 45 minutes! You’d better get me SOMETHING.”

In other words, the patient EXPECTS the doctor to write a prescription for what the patient perceives to be “more than just” a cold.

If that doctor tries to educate the patient on the broader consequences of antibiotic overuse, the patient may very well continue to demand (DEMAND!) that the doctor write a prescription for an antibiotic (yes, here in the U.S. many patients aren’t afraid to tell doctor what they want prescriptions for). If that doctor refuses, the patient simply goes to another doctor, who is willing to write the prescription.

So I don’t care if we come up with nth generation macrolide / cephalosporin or we engineer a quinolone that won’t cause such serious adverse events that half of the drugs in that class has been pulled off the shelf…

I don’t care if we start ‘designing’ antibiotics that overcome a microbe’s awesome drug-effluxing receptors…

it is only a matter of time that we create enough selective pressure for a bug to breed and mutate into a superbug that not only will clip whatever enzyme an antibiotic uses to disable the superbug’s replication system but will pump and dump that antibiotic faster than you can say “vancomycin”.

The most important thing we can do is to curb society’s demand for antibiotics for conditions that does not warrant antibiotics, and hope that pharmaceutical sciences can catch up with the superbugs.

Behavioral Economics in Personal Finance: How to Stop Over-Spending

Step 1: Control Your Purchasing Impulse By Removing Your Purchasing Ability.

Stop using all credit cards and use only cash. When you run out of cash, you don’t have money to buy anything anymore. You can be a major shopaholic: shop only in cash.

There are behavioral economics studies that have been done about what happens when your money is too far removed from cash. As soon as you abstract actual cash into a different form like tokens (as close to cash as you can get short of the actual coins) and then credit cards, your willingness to spend on impulse increases.

I’m not saying you shouldn’t use credit cards ever, but until you are disciplined enough to buy only what you can afford and you can pay off your entire credit balance every month for at least 6+ months… then cash-only will build the kind of habit that can help you manage your personal finances better. How about trying cash-only system for 1 month? It’s only 30 days but is incredibly powerful at showing you what you can actually afford and how expensive the “cheap little purchases” begin to add up.

A preferable behavioral outcome of Step 1 is for you to look for creative ways to cut costs where you can, such as buying used items, shopping for bargain items, and selling items you no longer use.

Step 2. Track Every Single Dollar into and out of Your accounts to Maximize “Pain of Paying” Reminders

I don’t use fancy programs — a simple Excel spreadsheet works for me. You can use online sites like Mint.com and Bundle.com to track your bank accounts and credit card spends once you know you have the discipline to spend only within your means, or if you are absolutely unwilling to go all-cash-only for the next 30 days.

Being able to see and track every single purchase will continue to create “salience” of every dollar that is leaving your bank account, or every dollar you are borrowing at astronomical interests rates from credit card companies. I have my credit card email me every single time a charge over $1 is registered to my account. This means I will be reminded again of what amount I spent when I check my email, and it puts “the pain of paying” at the forefront of my mind. I also have the kind of credit card that requires full-balance payoff, so I can never hold a credit card balance that incurs any interest.

Step 3. Create Budget Projections for Next Quarter Spending.

Once you have 3 months worth of data, you start tracking trends. At this point I only track certain budget items (utilities mainly) on a monthly basis because I’m so familiar with the “typical” spending caps that any abnormal fluctuations will catch my attention. Having a budget will make you feel empowered. Since I’ve been doing this for a while, I begin to make adjustments based on major life events, such as how the household utility budget will change when we moved from an apartment to a house, and new costs that having a child will incur.

All this stuff may be a pain in the butt to make habitual early on, but once you do this and get used to it, you will make use of this every year for the rest of your life.

Part of Step 3 is also the Creation of, and Insurance for, a Financial Buffer. Some people call this an emergency fund, and it is basically a pad of financial security you save up for yourself for emergency situations to prevent yourself from spiraling into (too much) debt.

In order for this to work, you need to make sure that you insure yourself against events that will put you into debt. In the U.S. these costs tend to be accidents and medical/healthcare, which means people in the U.S. must insure their healthcare costs as well as insure against certain accidents or liabilities relating to their property or their lives (especially if they have dependents).

How do you set spending limits to ensure you save toward your future?

Ever the Sluggish $BMY

Bristol Myers Squibb was hot commodity during ASCO and while remains at historically high prices, this stock is trading sideways around the $46-47 range as investors wonder whether they were intoxicated by all the hype around the BMS pipeline.
2013-06-17 11.45 AM109

Sibling Aggression is Bullying and not Benign

A new study that will be published in the July 2012 issue of Pediatrics suggest that bullying is bullying, no matter whether it came from a brother or sister – versus another peer.

I’d be interested to see the actual data on this (I don’t get this without an expensive subscription) — I wonder if the distress may be even more when the bullying behavior comes from a sibling because a child would trust that his own brother or sister would not hurt him as he may expect a stranger.

This study is making headlines all over Google this week.

Association of Sibling Aggression With Child and Adolescent Mental Health

Corinna Jenkins Tucker, PhDa,
David Finkelhor, PhDb,
Heather Turner, PhDb, and
Anne Shattuck, MAb

+ Author Affiliations

aDepartment of Family Studies, and
bSociology Department, University of New Hampshire, Durham, New Hampshire

Abstract

OBJECTIVE: Sibling aggression is common but often dismissed as benign. We examine whether being a victim of various forms of sibling aggression is associated with children’s and adolescents’ mental health distress. We also contrast the consequences of sibling versus peer aggression for children’s and adolescents’ mental health.

METHODS: We analyzed a national probability sample (n = 3599) that included telephone interviews about past year victimizations conducted with youth aged 10 to 17 or an adult caregiver concerning children aged 0 to 9.

RESULTS: Children ages 0 to 9 and youth ages 10 to 17 who experienced sibling aggression in the past year (ie, psychological, property, mild or severe physical assault), reported greater mental health distress. Children ages 0 to 9 showed greater mental health distress than did youth aged 10 to 17 in the case of mild physical assault, but they did not differ for the other types of sibling aggression. Comparison of sibling versus peer aggression generally showed that sibling and peer aggression independently and uniquely predicted worsened mental health.

CONCLUSIONS: The possible importance of sibling aggression for children’s and adolescents’ mental health should not be dismissed. The mobilization to prevent and stop peer victimization and bullying should expand to encompass sibling aggression as well.

GSK Trading Sluggish on Avandia Saga

2013-06-10 11.31 AM105 Around ASCO time GSK was a promising stock being touted by life science investors as one of those undervalued stock that you can go both long and short. Even with the Avandia scandal going on, you’d think that GSK is almost invincible.

Except it isn’t.

Headlines around Avandia still dominates investor consciousness and even though GSK is more than Avandia, this goes to show that a little bit of bad news that lingers on too long can hurt investor confidence and such ambivalence has been playing out in GSK stock price these past couple of weeks.

$GSK needs to get close to $52.50 and break past this to regain investor confidence. The stock price seems tentative about it, teasing that $52 threshold.

The Bigger the Marketing Machine The Smaller the Cause Relevance

I saw this post from my friend Casey Quinlan about the Susan G. Komen foundation canceling various events across the U.S. due to public backlash of what the public perceives as the foundation’s foray into political stances:

2013-06-06 11.10 AM104

I don’t know what’s happened with Komen but the corporate good will seems to have declined the bigger it’s gotten. Maybe Susan G. Komen foundation needed to stay more a corpus supporting grass roots level chapters as opposed to this major corporation painting everything pink.

What was ironic was that the pink ribbon concept was created by the late Ms. Lauder of Breast Cancer Research Foundation. I did not know that BCRF was the originator of the pink ribbon concept! I thought it came from Komen because this organization pops up *everywhere* I see breast cancer. What a pity that BCRF isn’t getting more recognition and activity about its work — but this also speaks to the formation of public consciousness: the better marketing machines gets the credit even when they may not have come up with the innovation.

Large “cause-based” organizations that consume 80%+ funds for overhead will run into this type of PR problem. Instead of funding research, education, outreach, even scholarships (think: children whose parents have passed due to cancer) — the infrastructure gobbles up the raised funds. This is also what causes frustration and resentment in consumers.

Marketing Works by Neutralizing Your Sense of Fair Market Value

The problem with customer “taste” or “preference” is that this is a subjective metric versus objective metric.

This is why marketing works by disrupting or neutralizing our sense of fair market value and at the same time, recalibrate our arbitrary sense of “worth” of a product.

Even if we have the means to objectively and rationally assess the “fair market value” of a product, marketing builds our perception around a product using very subjective measures that are meant to get us emotionally invested in the product, which then means we WANT to pay more because we will rationalize — “I’m worth it.”

A good example is the L’Oreal commercials here in the U.S. I don’t use their cosmetics but I have heard enough of their commercials to remember their slogan: “I’m worth it”.

— in other words, you can buy a $3 bottle of foundation from a no-name manufacturer. It contains the exact “key ingredients” as a $10-$15 bottle of brand name foundation. But hey — “I”m worth it!” Suddenly you are justified in purchasing a more expensive bottle of product because you are making a statement about your self worth NOT about fair market value.

Then — you add in subject aspects to that “worth it” marketing line, by adding perfumes and pretty bottles.

What has been even more interesting is how companies can now sell on “X-free”, and charge you more for giving you less.

Fragrance-free costs more than regular fragrance products.
Fat free costs more than regular fat-laden products.
Low sodium costs more than sodium-laden products.

Shouldn’t I pay more when I’m getting less?

No because I’m getting less “crap”, and I am taught by marketing that my health is worth the higher price I pay.

Why? Because I’m Worth It.

Naked Medicine © 2016 Frontier Theme