Now a joint publication of the FJMC and MRJ

Issue #51 -  March 07, 2018

This issue of HWR brings timely medical articles on the opioid epidemic, an “investing to change your wealth level” article on China investing and a section on “What We Have Read and FJMC Friends Who Have Written Us” that may pique your interest in important health and wealth topics.  Be sure to be in touch with Richard Gray, Editor, at rgray@fjmc.org with your articles, comments, appreciation and critiques.  Each issue is brought to you by your editorial staff that includes:

• Richard Gray (Editor in Chief)
• Steven Mandel MD (Medical Editor)
• Gary Smith (Wealth Editor)
• Mark Druy (Publisher)

HEALTH TIPS

The Opioid Epidemic -
Escalating Marijuana Use and Abuse and the Healthcare Provider

by Dr. Gerald Aronoff MD

In the last 2 decades, the US has witnessed and participated in a crisis in which there are now more drug overdose deaths than any other type of accidental deaths.  Although the media has fueled the public’s response to this problem, what is presented to the public is inaccurate.  That is, although the statistics generally call many of these overdose deaths opioid deaths, they are deaths related to multiple substances combined in overdose.  Most commonly this involves one or more opiates, alcohol, benzodiazepines (e.g.  alprazolam, clonazepam, diazepam, and other sedating drugs.  The drugs of choice for Street drug abuse have been expanded; although many individuals begin with experimenting with alcohol and marijuana as preadolescents and adolescents, over time, multiple opiates, heroin and cocaine frequently become drugs of choice, either by oral use, IV use or snorting. 

Many addicts are better educated about potential risks, by witnessing friends and family deaths from overdoses or from sharing needles and developing AIDS.  However, despite this, in many parts of the country, there are multiple deaths, initially said to be related to heroin, but often are heroin combined with an adulterated form of high potency fentanyl which often proves to be toxic and lethal. Many in the street addicted population are aware of their options for treatment but relatively few remain in treatment for adequate time to bring them into remission.  We now know that the population of active addicts is not limited to one age group, race, socioeconomic group, or sex.  For many of this population, the problem began in early life, either through unmet dependency needs, broken homes, parents who had substance use disorders and a variety of other deprivations.  Relatively few chose this dysfunctional lifestyle as their life’s dream.

Another group, through medical illness or injury, developed health problems for which, some health care provider(s) began prescriptions of opioid analgesics and, unfortunately, either continued to write the prescriptions for longer than necessary, or they failed to recognize when their patients were using the medications in a dysfunctional way consistent with substance misuse or abuse leading to dependency and addiction.  The healthcare providers may not have had adequate training in how to recognize and stratify patients at risk for a substance use disorder.  Some of these individuals continued to obtain regular opioid analgesic prescriptions even after their pain problem resolved or at the very least, no longer required opiates.  In retrospect, since I have reviewed many of these records, there is also a large group of patients who, in my opinion, never required treatment with opioid analgesics even early in their treatment.  There is adequate data from the various pain organizations as well as the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA) to indicate that prescription drug abuse has now overtaken Street drug abuse as a major public-health problem.

As a pain medicine physician for more than 30 years, who is also board-certified in substance abuse treatment, I find that dealing with the above populations is very difficult. When done in a comprehensive, coordinated, and individualized treatment approach, the results for bringing these patients into remission, having them replace maladaptive coping and a dysfunctional lifestyle with more adaptive coping skills and a functional lifestyle has been gratifying and very successful.  Many patients who had dropped out of school, were fired from jobs, or had a life of disability or unemployment have learned to replace these with more productive lives including work and/or returning to school.  Substance use disorders are major public health problems and dealing with them involves more than treating the patient.  We must put more of our resources into changing priorities in our healthcare system as it relates to substance use disorders and other mental health problems.

In the last decade, I have found myself lecturing to medical students and training physicians as well as more senior physicians making them more aware of the magnitude of some of the above problems but also helping them make decisions about another problem that complicates our pain management; that is, the patients who are legitimately taking medication for chronic pain including appropriately monitored opioids, but who are also using marijuana and/or alcohol or other substances along with their pain medication. Today’s marijuana is much more powerful and addictive than it was a generation ago.  The first step towards making marijuana more socially acceptable was the concept of “medicinal marijuana.”.  There were many states where marijuana was illegal.  However, if a physician found that patients had medical problems that did not respond adequately to conventional treatments such as medications for nausea or vomiting or for chronic pain and the healthcare providers could write letters saying that the patient was appropriate for use of Marinol or other forms of “medical marijuana” and that it was medically necessary.  In today’s comments, I will not have the opportunity to discuss the benefits and risks of marijuana. As a general statement, I will say that there is a subgroup of patients who may be appropriate for use of this drug in the management of certain types of neuropathic pain, intractable nausea and vomiting at times associated with chemotherapy, or other serious GI problems.  However, I have had many of my substance dependence patients tell me that it was very easy for them to find a physician who could be manipulated into writing such a letter allowing them to be found to be appropriate for use of medical marijuana.  There are now more than 25 states that have further made marijuana socially acceptable and now have legalized recreational marijuana.  I have been opposed to this, from the outset and believe that we have already started to see an increase in motor vehicle accidents related to increased use of marijuana and other substances.  I believe that we will see many more motor vehicle accidents, including pedestrian deaths related to these accidents as we see groups of people traveling in a car with multiple stoned marijuana users who will be more easily distracted, have a shorter attention span, delayed reaction time, other mental status changes, many of which they will not recognize, leading to tragic accidents.  Some of these marijuana stoned individuals may also be using prescribed or Street opiates. I have offered the opinion that this is a major accident waiting to happen; this crisis will evolve over time.  I have lectured on this and I have sent letters to some senior decision-makers such as City Mayors and State Governors offering my services to assist in working with them in the hopes of preempting catastrophic consequences.  So far, my recommendations have gone unheeded.

Dr. Aronoff is Medical Director at Carolina Pain Associates, PA.  He is past president of the American Academy of Pain Medicine and has authored/edited 8 books on chronic pain.  His latest book published this year is Medication Management of Chronic Pain: What You Need to Know.  Website is  GeraldAronoffbooks.com.  For book orders contact geraldaronoffmd@painexpert.com

WEALTH TIPS

We would like to thank our sponsor RCA, Retirement Corporation of America. They have graciously been our primary sponsor for the last 2 years.

A New Driving Force for China Investing -

The U.S. has 10 cities with populations of more than a million… China now has over 100 cities with more than a million residents
by Dr. Steve Sjuggerud

This article represents a “best of the breed” aggressive approach to investing and to aggressively convince readers to follow his advice while subscribing to his newsletter.  As with all aggressive marketing you have to make your own decision on how this fits into your life situation.  As shown on the included graph if not the text, the advice is great at times and awful at other times.  The key to success with aggressive investing is to be right more than wrong and have a tough gut.  Some people manage risk by making monthly investments to reduce timing effects.  Others have rigid stop losses and sell points to avoid mistakes of greed.  Much of the value of this article is to teach that we live in a changing environment, that risk can be rewarding and that “ you cannot win the lottery if you do not buy a ticket”.  And most North Americans cannot afford or are not mentally suited to get involved with high risk investing.  If you have investable funds be sure to have good financial advisors / sounding boards, define your goals, and enjoy.  Richard Gray and Gary Smith

“Steve, I remember your stories about visiting Pudong over 20 years ago. I remember your stories of your biggest investing mistake,” Brendan told me before he went to Xiongan. “I wanted to have a before-and-after photo standing in the same spot.”  Xiongan will be China’s third New Area. President Xi has big dreams for Xiongan. He said Xiongan should be an “internationally first-class, green, modern, and smart city,” and it should set an example of good public services and economic openness.  For more than 20 years, the “experts” have said it’s crazy that China builds cities without people in them, just expecting residents to move there. At first, I listened to them. Now I don’t. I just want to be on board – invested in China. And there’s a great reason to be on board over the next five years…

The Day We’ve Been Waiting for Is Arriving in June 2018

Hundreds of billions of dollars will ultimately flow into Chinese stocks… and the money will start to flow in mid-June 2018.  This may be the biggest story of my quarter-century career in the markets.  In short, in June 2018, the world’s largest stock index provider (MSCI) will start including local Chinese stocks in its global stock indexes. When that happens, investment funds that track those indexes will have to start including Chinese stocks in their holdings. Here’s why it’s a big deal…

Around $2 trillion in investment funds track the MSCI Emerging Markets Index. And that’s just one index. Over time, hundreds of billions of dollars will be forced into Chinese stocks once the country is included in international stock indexes.

The simple reason why so much money will flow in is: China is the world’s second-largest economy and it’s the world’s second-largest stock market (behind only the U.S).  Leaving China out of a global index of stocks is like leaving Apple out of an index of mobile-phone software… It doesn’t make sense. Apple’s iOS is second behind Google’s Android software.  This is clearly a wrong that needed to be righted.  Nobody is paying attention to local Chinese A-shares – yet. Hundreds of percent gains are truly possible – in a relatively short period of time. I’m not kidding…

One trillion dollars – or more – should flow into Chinese stocks and bonds in the next five to seven years. This will happen whether it’s a good idea or not to invest in China – as global fund managers are forced to mimic their benchmark indexes. These benchmark global indexes will include China A-shares for the first time starting in June of 2018.  Global fund managers are ramping up their presence in China, aiming to be well ahead of June 2018.  Private investment-management firm Neuberger Berman plans to relocate its Chinese equity research shop from Hong Kong to mainland China, according to Reuters. And 20-plus global managers have set up investment subsidiaries in China – including Fidelity, Vanguard, and Allianz.  These folks are behind the curve. They haven’t focused on China. At least not well enough. But they must now…

Now Is Your Best Moment to Profit.  Hundreds of billions of dollars will flow into local China “A” shares – as opposed to the shares that trade in Hong Kong – over the next five to seven years.  My recommendation is, get your money there first.  Nobody is paying attention to local Chinese A-shares – yet. Hundreds of percent gains are truly possible – in a relatively short period of time. I’m not kidding…

Here’s how… Chinese stocks have soared by more than 100% three separate times in the last 12 years.  The local Chinese investors can get euphoric very quickly. When the gains happen, they typically happen fast. Based on history, once the markets get moving, the bulk of the gains happens within 12 months. You want to be there early – like now!

So how do we best take advantage of the big opportunity in China?  It’s difficult for Americans to buy China A-shares directly. The simplest way for us to invest is through an exchange-traded fund that tracks China’s A-shares.  Your best option, in my opinion, is the KraneShares Bosera MSCI China A Share Fund (NYSE: KBA)  Okay. KraneShares is a rare U.S. firm that actually focuses on China-based investments.  This is the optimal moment to buy into Chinese A-shares…Hundreds of percent gains are possible. Hundreds of billions of dollars are about to flow in.  My advice? Get your money there first.

This trade could lead to – in all seriousness – some of the biggest gains of your life.

Throughout his career, Dr. Steve Sjuggerud has addressed hundreds of financial conferences in the U.S. and around the world, including at the New York Stock Exchange. He has also appeared in the media, including Bloomberg, Fox Business News, the Wall Street Journal, and Forbes. Steve holds a doctorate in finance and has worked as a stockbroker, vice president of a $50 million global mutual fund, and a hedge-fund manager.  Steve is editor of True Wealth, an investment advisory that specializes in safe, unique alternative investments overlooked by Wall Street. He recommends opportunities based on the simple idea that you don’t have to take big risks to make big returns.

SPECIAL BONUS SECTION

What We Have Read and FJMC Friends Who Have Written Us

There is a lot of health research that you may not have noticed. 

The 'New' Disease You Already Have – from Dr. Elfrig’s Health Wealth Bulletin

An alarming rate of Americans have this "new" disease.  You've probably never heard of it. But up to 46% of you reading this likely have it. It's called nonalcoholic fatty liver disease, or NAFLD.  This isn't some dummy disease drummed up by drug companies like ones we've warned you about before.  It's a problem that's been around, but it's expanding along with our waistbands. Worse, NAFLD can cause everything from liver failure to cancer. Researchers warn we could see a big jump in liver-cancer deaths if we continue to ignore this problem…

Infrastructure: An Investment In Our Future

With all of the recent headlines about increased spending on infrastructure, we should try to understand the implications for us as investors.  Infrastructure serves as a foundation for long-term economic growth. It spans multiple industry sectors and connects people, resources, and information. Infrastructure investment improves water quality, delivers energy and electricity, boosts transportation access, and increases broadband adoption.

McKinsey Global Institute estimates that nearly $50 trillion (yes, with a T) is required in the next two decades, merely to keep pace with projected economic growth.  Historically, investments in infrastructure were limited to the largest pension funds and endowments. However, it is now possible for individuals to build a portfolio of stocks of companies devoted to sectors such as water, utilities, pipelines, airports, ports, toll roads, and cell towers.

Investment in infrastructure can potentially provide the following benefits:

• High barriers to entry and monopolistic characteristics – capital intensive, large scale assets with high development costs prevent significant competition
• Steady, predictable cash flow with strong yield – assets are long-lived and backed by long-term contracts or concessions, which support predictable returns to shareholders
• Inflation protection – regulated price mechanisms or concession increases linked to inflation
• Low sensitivity to changes in GDP – inelastic demand for essential services tend to be much less sensitive to business cycle fluctuations

Publicly listed infrastructure securities could be an ideal fit for the portfolio of those in retirement or nearing retirement age. In addition to favorable dividend yields, publicly listed infrastructure investment may provide strong diversification potential with a lower fee structure as compared to private funds or partnerships. In addition, it is highly liquid, with high levels of disclosure, low investment thresholds, and no need for investor operating expertise.

Silkworth Capital Partners was founded in 2016 by Joshua Kohn with the intent of bringing institutional investment expertise to individual, advisory, and institutional clients. Silkworth Capital takes a holistic approach to investing and focuses on the key mega-trends across infrastructure sectors that will impact the world in coming decades.  Silkworth Capital product offerings include long-only and long-short infrastructure funds, as well as an Environmental, Social, Governance (ESG) focused fund.  To learn more, see www.silkworthcapital.com or email jkohn@silkworthcapital.com

The 3 Insurance Coverages Every Man Should Want (I Only Sell Two of Them)

The desire to own things we want in our lives creates a passion which motivates us to take the action needed to achieve that success, and we learn this behavior at a very early age.  WANT is a positive emotion, and one that is easy for us to support subconsciously.  Most of us feel we need insurance, but how can we bring that same passion to wanting the outcomes that an insurance plan might offer?

Life Insurance: Our need for life insurance changes over time.  From wanting to make sure income is replaced and debts are paid should something untimely and unexpected happen to wanting to use financial leverage and leave a legacy where possible.  No one questions the type of life insurance you owned if you passed away, they only cared that you had it.  Demonstrating for others that we prioritize meeting our obligations and showing them how much we care, this is the last opportunity most of have to deliver these messages.

Long Term Care Insurance: The likelihood of needing extend care at home, or in a nursing facility, approaches 70% once you turn age 65. The high cost of providing care often puts family members in a difficult position as they balance their lives and the needs of loved ones.  You take the burden from the shoulders of family members by having a plan to pay for needed care services.  A long term care insurance policy is an efficient way to do this; if you have a life insurance policy with cash value you can consider exchanging the plan for one that also includes LTC benefits.  If you have gain in the policy, this may be a tax efficient way to pay for care.

Umbrella Insurance: While I don’t offer umbrella insurance, it’s an inexpensive way to make sure you have extra coverage to fill the gaps in your auto coverage and homeowners policies.  An umbrella liability policy covers a much higher limit (often to $1Million and above) and protects your assets from an unforeseen event, where the loss may exceed traditional coverage limits.  Going the extra mile is one more lesson to impart to others. 

David Hillelsohn, Founder of DHill Financial, LLC based in Oak Hill, Virginia provides insurance counseling in the areas of long term care planning, life insurance planning, income protection, Medicare preparation, and more.  He can be contacted at (703) 435-6028 or by email at david@dhillfinancial.com.

If you have any questions please contact Gary Smith at gvet@me.com or Richard Gray at rgray@fjmc.org

Email sent at approximately 1:30 am, March 7, 2018
 

LEGAL DISCLAIMER: This work is based on current events, interviews, corporate press releases, and what we've learned from several mentioned health and wealth newsletters. It is also based on some personal experiences. It may contain errors and you shouldn't make any investment decision based solely on what you read here. It's your money and your responsibility. FJMC is not making specific recomendations of stocks or bonds just possible ideas that might be considered for research and investing purposes. This information is being provided for informational purposes only.

FJMC - Federation of Jewish Men's Clubs - Involving Jewish Men in Jewish Life.  The FJMC involves Jewish Men in Jewish Life through Leadership   Innovation   Community