Real Estate Market Future Trends

Recently, a  Chief Economist of Fannie Mae, who was speaking at a conference. 

Many are not aware that Fannie Mae is a quasi-government agency that is heavily involved in the US housing sector. 

The economist was asked "what do you think of US housing right now?" He answered: “It’s overpriced.” 

His presentation went DEEP into the data, showing that US housing is “late in the cycle,” meaning that prices may soon reach their peaks and then suffer a substantial correction. 

Property prices nationwide across the United States have been rising at a much more rapid rate than wages and salaries. This is totally unsustainable. 

A number of prominent real estate investors and developers have also spoken anecdotally that they’re no longer buying. 

Everything is overpriced, and investment returns are falling. 

Even more amazing, he told us that banks financed his most recent deals at unbelievable terms-- they loaned him hundreds of millions of dollars to fund his real estate projects at just 3%, on an interest-only basis. 

This is crazy. 

Considering that the official rate of inflation in the United States is nearing 3%, the banks practically loaned him the money for free. 

Think about it-- he pays 3% interest, but the money loses nearly 3% of its value each year due to inflation... so essentially the money is zero cost. 

What an unbelievably stupid loan for the banks to make: as I remarked to the audience, the banks are once again putting their customers’ funds at risk and receiving zero return in exchange. 

This is another sign of a major bubble, similar to what happened ten years ago in the last crash. 

Property prices rose far too much, far too quickly… and banks were making completely irresponsible loans with their customers’ money. 

 It appears that the same things are happening once again. 

Paddy Deighan
http://www.irstaxdebt.pro

Health Risks Associated with Tattoos

Tattoos are an art, a way of self-expression. But if you're not careful, they may also cause a string of health risks. This is why health authorities warn against the safety of getting tattoos, especially when tattoo inks are not heavily regulated by the FDA. Here are some health risks associated with applying tattoos to one's skin.

1. You may be allergic to ink or its materials. In May, NBC News reported that according to a new study conducted in New York City, 6 percent of respondents experienced skin problems more than four months after having tattoos applied to their bodies. Additionally, two-thirds of those who reported that they experienced rashes admitted to having allergies. Another study showed that red ink was linked to more rashes than other colors.

2. You're at risk for infections. The application of tattoos involves piercing the skin with a needle to inject colored ink below the skin's surface, so you may be at risk for infections, especially if the parlor you're getting a tattoo at is not clean. The FDA warns that dirty needles may pass infections such as hepatitis and HIV.

Dr. Marie Leger, a dermatologist at the New York University Langone Medical Center in New York City, also said that ink can also be contaminated by bacteria, which can pose a threat to your health. In 2012, an outbreak of skin infections spread in upstate New York, where a batch of grey ink which was contaminated with mycobacteria that caused Mycobacterium chelonae, was used. This type of bacteria is a relative of the mycobacteria that also causes tuberculosis and leprosy.

3. You're more prone to itching and redness from sun exposure. LiveScience reports that according to a Danish study conducted in 2014, researchers found that 42 percent of tattooed sunbathers had adverse reactions, mostly due to sun exposure. Respondents reported swelling, itching and redness.

Additionally, when yellow ink is exposed to the sun for prolonged periods of time, the cadmium in the ink creates a reaction that can cause itching, redness and raised skin.

Not to mention that darker color tattoo ink will absorb more sun than natural skin tones and consequently, there is a greater risk of skin cancer.

4. You may encounter difficulties getting MRI's. The Huffington Post reports that those who sport tattoos may have problems getting magnetic resonance imaging exams, especially those with more black ink on their skin, because the ink contains iron oxide. In 2011, a case report showed that a professional football player's black tattoo was "burned" while he was getting a MRI, and this resulted from electric currents forming in the iron in the tattoo ink.

5. You may be at risk for nerve damage from carcinogenic nanoparticles found in ink. Health Impact News reports that according to a 2011 study published in The British Journal of Dermatology, nanoparticles can be found in tattoo inks, and black ink contains the smallest particles. The study also showed that some nanoparticles may be carcinogenic, or toxic enough to cause brain and nerve damage.

"Black tattoo inks are usually based on soot, are not regulated and may contain hazardous polycyclic aromatic hydrocarbons (PAHs). Part of PAHs possibly stay lifelong in skin, absorb UV radiation and generate singlet oxygen, which may affect skin integrity," the study authors wrote. "Tattooing with black inks entails an injection of substantial amounts of phenol and PAHs into skin. Most of these PAHs are carcinogenic and may additionally generate deleterious singlet oxygen inside the dermis when skin is exposed to UVA (e.g. solar radiation)."

Paddy Deighan J.D. Ph.D

http://www.medicalandspaconsulting.com

When are Spa Services Considered to be Medical Treatments

I have written many articles on what services are medical and which ones are spa.  Despite what appears to be a clear line, there is a lot of questions concerning this distinction. I respond to many threads on LinkedIn as they relate to this topic and I am a bit surprised at the misinformation and lack of understanding that medical treatments may only be performed in a "medical" environment.

Accordingly, I can add some additional thought to further clarify the distinction between spa and medical treatments.  If a product or service is such that the implements or device used in the treatment requires  or is recommended for sterilization, then the service is almost always medical.

I recently read a review of a micro-needling device.  The device suggested that the components be sterilized in an autoclave after use. This all but assures that the treatment is medical. If there is any possibility of infection or transmission of pathogens, then a treatment will be considered medical. You may recall from prior articles that I have written, that there are two many issues in regard to whether a product, treatment, or service is medical : 1). is the treatment or product intended to diagnose or treat a medical condition and 2). is there a medical device being utilized in the delivery of the treatment.

Professionals constantly say to me that the manufacturer states that the service or device is not medical.  The New Jersey in me would respond that it is not their license on the line when they state that.  From a more practical view, you can review the FDA position on a device.  Ask the manufacturer if the device is a Class II or higher medical device.  The FDA indication will be visible on the device packaging or the device itself. If the device is Class II or higher, it does not matter what the manufacturer is telling you - the device IS by its FDA clearance, a medical device.

In one instance, an esthetician advised me that her state cosmetology board advised her that it is acceptable for her to perform micro needling.  My response was that she needs to ask the medical board (or nursing board) and the FDA.  She will receive different answers from those entities.

As I am known to say..."the answer you receive depends upon the question that you as and with whom you inquire".

Paddy Deighan J.D. PhD
http://www.medicalandspaconsulting.com

Not Medically related but REALLY Interesting!!!!

We are all a bit if Jurassic history nuts so I had to pass this along.  Dinosaur footprints were uncovered in a beach in Germany.  Accordingly, there are a number of interesting aspects to this:

1). The dinosaur footprints are estimated to be about 140 MILLION years old;
2). It appears that dinosaurs were more social than previously believed;
3). Germany has beaches AHAHHAHAHAHAHA

It is truly astounding to discover footprints that are 140 million years old.  After all of that time, they came to the surface between 2009 and 2011.  Why now? Can you imagine the series of events during the past 140 million years?

Stories such as this are fascinating to us..

Actually, upon closer inspection, maybe this story is about medical spa issues.  It certainly appears that our Jurassic friend needs a mega dose of Botox Cosmetic!!! ahahahahaha


Here is a link to the original story.

http://www.aol.com/article/2015/08/17/footprints-of-dinosaurs-strolling-on-the-beach-found-in-germany/21223733/?icid=maing-grid7%7Cmain5%7Cdl23%7Csec1_lnk3%26pLid%3D175989300

Have a wonderful day, 

Paddy Deighan
http://www.medicalandspaconsulting.com

Which Medical Spa Treatments can an Esthetician Perform?

I am frequently asked to comment on the distinction between what is medical and what is aesthetic (non-medical)....the lines are blurry but in my opinion, they are being violated on a daily basis. The practice of medicine is relatively easy to define....it is the diagnosis OR treatment of a medical condition.  Good, bad or indifferent, acne, rosacea, eczema are medical conditions. Some things may not be as clear...for example, treating "razor bumps" MAY not be medical, but on the other hand, those "razor bumps" are Pseudofolliculitis barbae  and then they would be medical. Frustrating...I know.

Additionally, the next level of analysis would be whether any medical device or product is being utilized in the treatment and of so, what federal classification is the device. Virtually all aesthetic lasers AND IPLs are Class II or Class IIb medical devices and they have to be owned and operated by licensed physicians (not RNs). Physicians may, in certain circumstances, delegate "operation" (but not ownership) to other individuals.

Many products are medical...Botox Cosmetic is a prescription drug...100% medical. The dermal fillers (Restylane for example) are all medical PRODUCTS (not a drug). They are still 100% medical but for a different reason.

In laser, you can look at two different types of scenarios...let's use laser hair removal and the treatment of leg veins.  Laser hair removal is NOT a medical procedure. However, if the patient is hirsute because of polycystic ovary syndrome (PCOS), then it IS medical.  In this situation the treatment may not be medical but the device IS medical. Hence, laser hair removal IS medical.

Treatment of leg veins...this is both a medical treatment and a medical device. Two reasons not to perform this service.

With peels, it gets REALLY complex...one analysis would be to look at FDA guidelines. In 1996 the FDA concluded that "medical" is a product that penetrated the epi-dermal/dermal junction. They concluded that a 30% glycolic treatment achieves this. Prior to 1996, they mandated that a 40% glycolic solution achieved this. But what 30% glycolic? pure 30%, neutralized or buffered 30%?...remain unanswered. Soooo, if you utilize a 40% glycolic solution but you know that it is neutralized or buffered, then you are probably OK.

Jessner's peels and most TCA peels are mid-to high level strength peels and they are medical. Sal acid is non medical unless in high strengths....hydro quinones are non medical if they are under 2%...we could go on for hours...topical anesthetics can be medical or non medical too...depending upon the strength and formulation (this is actually a HUGE issue)

The problem is that regulation comes in the form of....state statutes, state and federal case law, federal mandate (FDA, FTC), state boards of medicine, cosmetology and nursing, Attorney General reports and cases...WHEW. There is no ONE place to look!

Recently, there was a discussion and an esthetician commented to me that she contacted her state board in NH. They said that as long as she was certified, it was OK for her to perform the procedure (I do not recall the specific procedure, but on its face, it was medical ...blade or syringe was utilized if I recall). That may have been true by NH board purposes, but federal law would disagree and Federal law trumps state law.

Paddy Deighan J.D. Ph.D

http://www.medicalandspaconsulting.com

Time for Another Look At Employee Contractor Status in Medical Spas

The employee/Independent contractor scenario in spas and medical spas is very complex. The determination of whether a professional staff member is an employee or independent contractor is not easy to address. One thing that IS clear; the agreement that may be in effect is not the most significant issue. You can classify a professional staff member whatever you want to call them in an agreement, but this does not control the ultimate determination.

Many owners and professional staff want to be independent contractors but the reality is in many cases, the relationship is not sustainable. The Internal Revenue Service (IRS) has been looking at the spa industry more closely (possibly due in large part to tipping structures, but they are looking at the industry). The Service has been looking at many “tip” based businesses such as the taxi industry, restaurants and salons and spas.

The IRS has ruled sometimes that an independent contractor was really an employee because the business supplied TOWELS and LINEN! WOW!

A fundamental approach will be based on two key aspects of the relationship: 1. "control" over the professional staff members hours and days of service, and 2. requirement to utilize certain product lines or practice policies and protocols for certain procedures.

These are not easy issues to address because there are conflicting issues and goals. On one hand, the medical spa needs staff to be available during operational hours. It would be problematic to allow professional staff to decide the days and hours of service. However, providing schedule is a strong element of “control” over the staff member and this tends to be an employment situation.

The second issue is no less problematic.  A professional staff member may support a certain product line that is not offered by the facility. He or she may have a different protocol for a procedure.  The professional staff member may have his or her own protocols for a procedure – even something as seemingly straight forward as micro-dermasbrasion.  An ancillary concern is when there is a mixture of employees and contractors. The contractors may have more freedom to perform services and procedures and they deem appropriate and this can cause staff problems.

I address many such issues every day and please see my website Medicalandspaconsulting.com

Paddy Deighan J.D. Ph.D

http://www.medicalandspaconsulting.comMedical and Spa Consulting

Lasers May Repair Teeth...No More Fillings and Cavities and Root Canal!!

For the millions of Americans who suffer cavities each year, the ominous threat of a root canal may soon be a worry of the past.

Now, researchers from Harvard University claim they have discovered a novel way of regrowing parts of people’s teeth using an unlikely tool: Lasers.

In a new study published in the journal Science Translational Medicine, lead researcher Praveen Arany and colleagues detailed how they used focused laser light therapy on rats to stimulate the growth of lost dentin, the calcified tissue that comprises teeth.  They noted that if the therapy proves effective in humans, it could potentially eliminate the need for crowns, fillings and other complex dental operations in the future.

The procedure’s success all revolves around a native protein called transforming growth factor beta, or TGF-beta.  During preliminary tests of dentin tissues, the researchers discovered that this growth factor changed very drastically when introduced to a focused beam of light.  Further analysis revealed that when hit with light, TGF-beta actually stimulated the stem cells already present in dentin.

“Once [TGF-beta] is activated by the laser, it can bind to stem cells resident in the tissue, and then it induces those stem cells to differentiate so they can proliferate and reform dentin,” David Mooney, the Pinkas Family Professor of Bioengineering at Harvard University, told FoxNews.com.

Numerous studies have focused on ways to manipulate stem cells in order to spur tissue regeneration, but most of these techniques have revolved around reintroducing altered stem cells into the patient or directing stem cell populations externally through added growth factors.  With this form of laser therapy, the only external factor that is being introduced is light, which activates TGF-beta that’s already in the body.

According to Mooney, it’s not the laser’s heat that stimulates TGF-beta but the energy of its photons.  When light is focused on dentin, the photons get absorbed into the tissue and activate molecules called reactive oxygen species (ROS), which naturally occur in the body.  These ROS then stimulate TGF-beta, which spurs the chain reaction ultimately leading to dentin reformation.

However, Mooney noted that the power of the laser must be at a specific level of intensity and cannot produce any heat in order to be effective.

“It’s kind of like Goldilocks, too little won’t do enough and too much will become destructive,” Mooney said. “It has to be just right.”

To test their light therapy’s effectiveness, the researchers created a group of rats with tooth defects, by using a drill to remove pieces of their dentin.  They then shined a laser on their exposed tooth structures and soft tissues underneath it.  Sure enough, after 12 weeks, the team observed that new dentin had formed in the rats’ teeth.

Given their trial’s success, Arany and his team hope to test this type of dentin regeneration in human clinical trials, which could potentially alter modern dentistry.  Currently, if a patient has a chipped or decayed tooth, dentists will use synthetic materials to fix the problem or perform a root canal if the tooth has become too infected. Yet, Arany noted that laser therapy could erase the need for these uncomfortable dental procedures, simply by regrowing the part of the tooth that is missing.

He also noted that focused laser therapy could be used to grow more protective dentin in teeth that have grown sensitive due to gum recession.

“As we grow older our gums recede, exposing our teeth root,” Arany, assistant clinical investigator for the National Institutes of Health, told FoxNews.com. “The root is covered by cementum, which is not as protective as enamel, so you get dentin sensitivity….What we hope is in tooth sensitivity, [laser therapy] is able to generate an intrinsic protective barrier on the inside of the tooth.”

Expanding beyond the world of dentistry, the researchers note that TGF-beta is found in other bodily tissues, such as skin and bone, and that laser therapy could potentially help regrow tissues in those systems, as well.  Also, since TGF-beta is known to control tissue inflammation, the growth factor could perhaps be stimulated to control certain inflammatory diseases.

But for now, the team is focused on TGF-beta in relation to teeth, and they are hopeful that their laser therapy could be used in a clinical setting relatively soon.

“This laser is already a big part of the clinic, since so many of the clinicians use it for other purposes,” Arany said.  “So the barrier to clinical trial translation is relatively low.”

Paddy Deighan J.D. Ph.D

http://www.medicalandspaconsulting.com