Current Events in January 2019

The housing market experienced a sharp drop in December as sales of existing homes fell 6.4 percent, the largest one-month decline in three years. On a year-over-year basis, sales fell more than 10 percent.

The National Association of Realtors (NAR) reports sales were down in all regions of the country last month. The sharp drop put an exclamation point on a housing market that has shown increasing signs of weakness as both mortgage rates and home prices have risen, pushing up the average monthly payment.

“The housing market is obviously very sensitive to mortgage rates,” said Lawrence Yun, NAR’s chief economist. “Softer sales in December reflected consumer search processes and contract signing activity in previous months when mortgage rates were higher than today. Now, with mortgage rates lower, some revival in home sales is expected going into spring.”

But the drop in sales didn’t really affect the price buyers were willing to pay for a home. The median sale price of all existing homes increased 2.9 percent over December 2017. In fact, the median home price has now risen for 82 consecutive months.

Supply and demand

One logical reason for the rise in home prices is the supply of available homes. Total housing inventory continued to fall in December, with 200,000 fewer homes on the market than the previous month.

David Berson, chief economist at Nationwide, told CNBC that he links the sales decline to rising interest rates. Not only does it affect affordability for first-time buyers, but people who already own homes and are paying a much lower interest rate are less inclined to sell their home and buy another because they want to avoid taking on a mortgage at a higher rate.

With fewer consumers purchasing homes, mortgage companies are making fewer loans, which is cutting into profits. In response, The Wall Street Journal reports lenders are loosening underwriting standards on some loans to make it easier for some consumers to qualify for a mortgage.

Deja vu

If that sounds familiar, it was a widely accepted practice during the housing bubble and blamed by some for the collapse of the housing market when many of those loans defaulted. The Journal report says there are similarities and differences to those previous undocumented loans.

While traditional mortgages still require at least two years of employment in the same industry and pay records to prove it, the new “non-traditional loans” allow a loan applicant to document income with bank statements and letters from clients.

The Journal cites data from Inside Mortgage Finance, an industry research group, showing that mortgage companies wrote up $34 billion in these non-traditional loans in the first nine months of 2018. That’s a small segment of the overall mortgage market, but it’s a 24 percent increase over the first nine months of 2017.

Torrent Pharmaceuticals Limited is expanding its earlier recall of Losartan potassium tablets USP to include six lots of Losartan potassium and hydrochlorothiazide tablets, USP.

Trace amounts of an unexpected impurity, N-nitrosodiethylamine (NDEA), which has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC) classification.

There have been no reports of adverse events.

The following products, used to treat hypertension, hypertensive patients with Left Ventricular Hypertrophy and for the treatment of nephropathy in Type 2 diabetic patients, are being recalled:

The recalled products were distributed nationwide to Torrent’s wholesale distributor, repackager and retail customers.

What to do

Patients who are on Losartan should continue taking their medication, as the risk of harm to the patient’s health may be higher if the treatment is stopped immediately without any alternative treatment.

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication.

Torrent Pharmaceuticals is notifying customers by phone and in writing, arranging for return of all recalled products to Qualanex. Instructions for returning recalled products are given in the recall letter.

Consumers with medical questions or reporting an adverse event may contact Torrent at (800) 912-9561 8:00 am – 5:00 pm (ET), or by email at Medinfo.Torrent@apcerls.com

Questions regarding the return of the recalled product may be be directed to Qualanex at (888) 280-2040 from 8 am - 9:00 pm (ET).

Canada Herb is recalling Canada Herb brand Red Chili.

The product may be contaminated with Salmonella.

There are no reported illnesses associated with the consumption of this product.

Canada Herb, sold at retail stores in Ontario, Canada, is being recalled:

• Common name: Red Chili
• Size: Variable weight
• Code(s) on product: None – all packages sold up to and including January 20, 2019

What to do

Customers who purchased the recalled product should not consume it, but discard it or return it to the store where purchased.

Consumers with questions may contact the company at (647) 627-4173 or by email at canadaherb141@yahoo.ca.

Media researchers at The Diffusion Group (TDG) have uncorked a new study that finds 79 percent of Amazon Prime consumers love its unlimited two-day free shipping more than any of the other Prime perks -- Prime Music, Prime Pantry, Prime Book Box, etc. -- with Prime Video lagging far behind at a meager 11 percent.

Two-day shipping is an easy task for Amazon given its warehouse empire of more than 75 fulfillment centers and 25 sortation centers dotted across North America. And Amazon’s treasure trove of anything and everything provides an endless loop for the online shopper.

However, the other big players in the online shopping world are putting Amazon on notice. WalMart stood up to Amazon by extending free shipping to third-party sellers' products and simplifying the return process, and Target upped the ante with the launch of its same-day shipping service and its curbside pickup service, “Drive Up.”

Kroger and CVS are all-in for the delivery game as well and looking for their own piece of Amazon’s action, not to mention some of its 100 million members.

“Amazon Prime has become synonymous with free shipping,” Michael Greeson, President of TDG, told ConsumerAffairs “and this has been critical to its rapid growth. Competitors have long been aware of this fact, but have failed to match Amazon or, when they have adopted the free-shipping model, to effectively communicate its availability, thus allowing Amazon to dominate the messaging. Wal-Mart, Target, and others need to put free shipping front in center in their branding efforts, versus positioning it as value-add.”

The long tail

How this dance for online shipping supremacy will shake out will be interesting to watch.

“While Amazon Prime is building robust audiences in video, music, and gaming, Prime is first and foremost about developing more and broader retail relationships, and free shipping is key to that mission. That is where the real value of Prime lies,” noted Greeson.

And the long tail of Amazon Prime -- lumping in video, music, books, and food into the Prime-available family -- is a bonus.

From Greeson’s purview, Amazon has made the right moves to draw in new subscribers by focusing on providing the right high-quality digital assets.

“Once they begin to buy more merchandise, however, service value appears to shift from media to free shipping. This is not to diminish the value that digital media services add to the Prime equation, but it puts it into perspective relative to retail,” he added.

The partial government shutdown, now in its fifth week, has caused a spike in the rate of unscheduled absences among Transportation Security Administration (TSA) workers.

In a Monday press release, the TSA said the rate of worker absences hit 10 percent on Sunday. On the same Sunday last year, the rate was just 3.1 percent.

"Yesterday's complete figures show that TSA experienced a national rate of 10 percent of unscheduled absences compared to a 3.1 percent rate one year ago on the same day, Jan. 20, 2018," the TSA said. "Many employees are reporting that they are not able to report to work due to financial limitations."

Surge in absences

Most passengers who passed through U.S. airports on Sunday experienced waits of less than 30 minutes, which is “within normal TSA times,” according to the agency. However, “some airports experienced longer than usual wait times” due to the increase in worker call-outs.

Over the weekend, one security checkpoint at Baltimore/Washington International Thurgood Marshall Airport had to be closed due to “excessive callouts.” The TSA announced on Saturday that it would be “exercising a contingency plan” at the airport.

“Checkpoint A will be closing at 5:35pm,” the agency tweeted. “Passengers should arrive early for evening flights. Contact airport & airlines for updates.”

The TSA urges those who will be boarding a flight amid the ongoing government shutdown to seek current airline and airport information and allow enough time to get through the airport.

Backlash from federal employees

Earlier this month, the National Air Traffic Controllers Association (NATCA) filed a lawsuit in United States District Court on behalf of its members who haven’t been paid since December 28.

"Every moment of every hour of every day, the skies of the United States are overseen by the hardworking employees of the United States Federal Aviation Administration ("FAA")," the association wrote in its complaint. "Each day, the FAA's Air Traffic Controllers are responsible for ensuring the safe routing of tens of thousands of flights, often working lengthy, grueling overtime shifts to do so. In fact, plaintiffs' job is so demanding and requires such rare skills that the FAA struggles to maintain a full complement of certified Air Traffic Controllers, even under normal circumstances.”

Once the shutdown ends, workers will likely receive back pay. However, it still appears as though there’s no end in sight.

President Trump recently proposed to offer temporary protections for young immigrants, known as Dreamers, in exchange for the $5.7 billion he has demanded for a border wall. Democrats have said that they find the proposal unacceptable. Senate Minority Leader Chuck Schumer (D-N.Y.) said the plan equated to “more hostage taking.”

One week after Tesla raised Supercharger prices, the electric car maker has announced that it’s reducing charging costs by 10 percent in response to customer backlash to the change.

The company told Elektrek that its decision to trim Supercharger costs came in response to feedback from customers who were unhappy about the recent price increase.

Last week, Tesla raised the per kWh rates for its charging stations by about 33 percent “in order to get more comprehensive prices based on local electricity rates and demand charges,” Elektrek reported.

Prices rose to 32 cents per kWh in parts of downtown New York City and 36 cents per kWh in some California markets. Tesla maintained that its electric cars would still be cheaper to fill than traditional cars and that it hadn’t hiked prices as a way to boost profits.

“We’re adjusting Supercharging pricing to better reflect differences in local electricity costs and site usage,” the automaker told Elektrek last week. “As our fleet grows, we continue to open new Supercharger locations weekly so more drivers can travel long distances at a fraction of the cost of gasoline and with zero emissions. As has always been the case, Supercharging is not meant to be a profit center for Tesla.”

The average Supercharger price is now down to $0.28 per kWh.

Starbucks is expanding its delivery service to an additional six major U.S. cities.

The coffee chain announced on Monday that the service will become available to consumers in San Francisco this week. In the coming weeks, the service will launch in Boston, Chicago, New York, Washington, and Los Angeles.

Starbucks said it’s aiming to offer the delivery service (which is made possible through a partnership with Uber Eats) at nearly one-fourth of its U.S. stores. Last fall, the company tested its delivery service at 200 stores in Miami and determined that the delivery option resulted in larger sales per ticket.

“We’re seeing an expanded ticket. And that average ticket is what we need to see happen as we approach delivery,” Roz Brewer, Starbucks’ chief operating officer, told CNBC.

Expanding out-of-store service

Starbucks said this week that the initial test in Miami resulted in strong demand, “including repeat business throughout the day and positive feedback from customers.”

“We know we have untapped customer demand for Starbucks Delivers in the U.S. and starting today, we’re expanding our best-in-class experience to our customers both in and out of our stores,” Brewer said in a statement about the expanded availability of Starbucks Delivers.

“We’re building on key learnings from past delivery pilots and by integrating our ordering technology directly with Uber Eats, we’ve unlocked the ability to bring Starbucks to customers for those times when they’re not able to come to us,” Brewer said.

Customers who request the delivery option will be charged a $2.49 booking fee. Starbucks says 95 percent of its menu will be available to order via the Uber Eats app on iOS or Android.

As we’ve reported, corporate leaders, from the largest companies to the smallest community banks, have recently become less optimistic about the economy in 2019.

But what about consumers? It appears many of them share the same sentiment. Personal finance site WalletHub has released a survey of consumers, and it reveals that just over a third of them -- 34 percent -- are worried about maxing out their credit cards.

That suggests two things; consumers racked up a lot of holiday purchases late last year that they have not begun to pay for. It also suggests that many consumers use their credit cards to get from one paycheck to another.

The survey also found that 36 percent of consumers have maxed out their credit card while making a large purchase, and 12 percent have done so more than once. However, a “large purchase” is subject to interpretation. Eighteen percent consider a $1,000 expense to be a large purchase while 30 percent classify $100 as a large purchase.

Using cards in different ways

The survey found consumers are using their credit cards in different ways. The majority don’t fear maxing out their card because they pay off most or all of the balance each month. The study authors say this group uses their credit cards to reap rewards and can do so because they have stable employment and expenses.

The study authors quote David Laibson, an economics professor at Harvard, as advising consumers who worry about maxing out their cards to pay with cash instead, calling it good financial discipline.

The survey also found that maxing out credit cards appears to be a middle class problem. Low income consumers are more likely to pay with cash.

“Low income individuals may have difficulty getting a credit limit high enough to support making a large purchase on a credit card,” said MaryAnn P. Monforte, an accounting professor at Syracuse University. “Many low-income-earners have also learned the hard way and are perhaps avoiding credit as a result. Low income individuals are 40 percent more likely than high-earners to have maxed out a card before.”

Reason for concern

Consumers who carry credit card balances may have reason to be concerned. The average credit card interest rate is over 17 percent and could go higher each time the Federal Reserve raises the federal funds rate.

Richard E. Sylla, professor emeritus of economics at New York University, says rewards credit cards are great, but only if you have the income and the discipline to pay the balance in full each month. Otherwise, the interest on the debt will easily exceed any rewards you might reap.

What a difference a year makes.

In January 2018, the annual PwC survey of global CEOs showed strong optimism about the economy. Corporate earnings were projected higher in the wake of a big tax cut, and the stock market reflected that optimism.

This month, PwC’s survey finds CEOs in a much more cautious mood and considerably less optimistic about the future. Corporate leaders’ moods are often influenced by things in their own backyard.

When asked about how they think their company will perform in 2019, 35 percent of CEOs said they are “very confident” their firm will experience solid growth over the next 12 months. That might sound pretty good, but it’s down 7 percent from last year’s numbers.

What’s changed? You don’t have to look very far. Trade tensions caused by the imposition of tariffs have had a negative impact on everything from agriculture, to automobiles, to computer chips. Sales have softened, and uncertainty abounds over the outcome of the standoff.

Shift in political climate

The political climate has also shifted with Democrats’ November election victories that handed them control of the House of Representatives. Further deregulation and tax relief are now completely off the table.

On top of that, the longest government shutdown in history, in a stalemate between Congressional Democrats and the White House, has no end in sight. It has begun to create a drag on business, with Delta Airlines recently announcing that the loss of government business will cost the airline $25 million in January alone.

CEOs are not just worried about their own businesses. When asked to gauge the overall economy, nearly a third said they expect a decline in global economic growth over the remainder of the year. That’s counterbalanced by the 42 percent who expect growth to pick up again in 2020.

Main Street pessimism

The pessimism seems to be filtering down to Main Street. A separate report by Cornerstone Advisors shows that CEOs of small community banks and credit unions are also losing confidence in the economy.

The bankers point to slowing loan growth, higher funding costs, and growing concern that credit softening will take a toll on earnings in the months ahead.

"The Trump bump is turning into the Trump slump," said Ron Shevlin, research director at Cornerstone Advisors and author of the 2019 report. “Bank executives that are somewhat or very optimistic about the coming year dropped 16 percentage points in the latest survey after a seven-point drop the previous year. Credit union execs who are optimistic about the new year tumbled by nearly 30 percentage points.”

Taken together, the two reports don’t necessarily point to a recession in 2019, but they do suggest a dramatically slower economy is not out of the question.

We’re in the midst of cold season, and parents are no doubt doing their best to keep their children from coming down with the sniffles.

But University of Michigan researchers say some of the methods they use, based on long-held and persistent beliefs, aren’t really helping. The team conducted a poll and found that about half of the parents they surveyed believe fortifying their children’s diet with vitamin C will ward off a cold. However, there’s no evidence to support that.

The survey found parents also believe going outside with wet hair will lead to a cold, or that staying inside will reduce your risk of getting sick. But the researchers say there is little or no evidence that supports this either.

Over-the-counter supplements

Just over half of parents in the survey said they have given their child an over-the-counter vitamin or supplement to prevent colds, even though there is no evidence that they work.

An even larger percentage of parents said they believe they can protect their child from catching a cold by following non-evidence-based “folklore” advice, such as preventing children from going outside with wet hair or encouraging them to spend more time indoors.

The researchers say they were gratified to learn that almost all parents -- 99 percent -- encourage good personal hygiene by their children as a way to avoid colds, a proven method. Parents say they tell their children to wash their hands frequently, not share drinks or utensils with others, and to keep their hands away from their mouths.

Positive news

“The positive news is that the majority of parents do follow evidence-based recommendations to avoid catching or spreading the common cold and other illnesses,” said Dr. Gary Freed,  co-director of the poll and a pediatrician at Mott Children’s Hospital.

However, Freed expressed dismay that so marny parents are also using supplements and vitamins not proven to be effective in preventing colds and that are not regulated by the U.S. Food and Drug Administration (FDA).

“These are products that may be heavily advertised and commonly used but none have been independently shown to have any definitive effect on cold prevention,” Freed said.

The common cold, a scourge because it has no cure, is caused by viruses that spread from person to person. The most frequent way people get colds is by ingesting tiny mucous droplets from the nose or mouth that become airborne.

Researchers say the best way to avoid a cold is avoiding direct contact with someone who has one. They encourage consumers to wash their hands after touching public surfaces, such as door handles, faucets, and countertops.

For many consumers, fainting spells are common after spending hours in the heat or when they haven’t had enough water. Though fainting can be a bit nerve-wracking, it usually doesn’t cross consumers’ minds after the initial shock has worn off.

However, a new study conducted by researchers from The Ottawa Hospital found that fainting can sometimes be a sign of a more serious medical condition, and some patients need to be monitored longer than others after fainting as a precaution.

“Before this study, we didn’t know which fainting patients needed to be monitored in the Emergency Department, and how long they needed to be monitored,” said lead author Dr. Venkatesh Thiruganasambandamoorthy. “We didn't know who needed to be hospitalized in order to catch life-threatening conditions. Now we have answers to these questions that will help improve patient care, and potentially reduce ED wait times and hospital admissions.”

Knowing who is at risk

The researchers set out to classify patients as either low-, medium-, or high-risk post-fainting based on their likelihood of developing an arrhythmia.

Prior to the study, Dr. Thiruganasambandamoorthy and his team developed a tool that doctors can use in the emergency room to help them identify the patients who appear to be at a higher risk of having an irregular heartbeat -- which is common after fainting, but can often lead to other medical conditions.

The researchers evaluated over 5,500 participants, 74 percent of who were classified as low-risk, 19 percent as medium-risk, and seven percent as high-risk. Within 30 days of fainting, over 3.5 percent of patients experienced an arrythmia, though it happened at different times for the patients depending on their risk classification.

According to the researchers, low-risk patients are usually able to leave the hospital after two hours, and they typically don’t require a follow-up appointment. However, both medium- and high-risk patients should stay at the hospital for at least six hours after fainting, at which point the doctor should decide whether they can go home with additional monitoring or stay in the hospital for more up-close monitoring.

“We learned that irregular heartbeat called arrhythmias usually happen soon after fainting,” said Dr. Thiruganasambandamoorthy. “This means we can catch most of these events in those first few hours in the Emergency Department, where we can quickly give people the treatment they need. The types of arrhythmias that medium-risk patients suffer are more important, but not life-threatening, so these patients can be monitored from the comfort of their homes. A few days in the hospital can be considered for high-risk patients.”

Though the researchers note that the majority of patients that enter into emergency rooms after fainting are low-risk cases, it’s important for consumers to be aware of the potential risks that are associated with fainting.

Other risks

While the researchers from this study were most concerned with patients developing arrhythmias after fainting, a recent study conducted by researchers from the Johns Hopkins Bloomberg School of Public Health found that fainting or dizziness when standing up from a seated position is linked to an increase risk of dementia or stroke.

Researchers say the lightheaded feeling -- or fainting spell -- which is known as orthostatic hypertension comes from a drop in blood pressure, but it could also be a sign of dementia or stroke later in life.

The study found that those who experienced orthostatic hypertension at a young age were over 50 percent more likely to develop dementia as an older adult.

“Orthostatic hypertension has been linked to heart disease, fainting and falls, so we wanted to conduct a large study to determine if this form of low blood pressure was also linked to problems in the brain, specifically dementia,” said researcher Dr. Andrea Rawlings. “Measuring orthostatic hypertension in middle-age may be a new way to identify people who need to be carefully monitored for dementia and stroke.”

Losing weight is at the forefront of many consumers’ minds, especially with the new year in full swing. As much as dieting and exercise go into shedding a few extra pounds, a new study found that for some consumers, it’s all about their genes.

Researchers from Uppsala University found that our genes affect where our bodies are storing fat, though this occurs more often in women than in men.

“We know that women and men tend to store fat differently -- women have the ability to more easily store fat on the hips and legs, while men tend to accumulate fat around the abdomen to a higher extent,” said lead researcher Mathias Rask-Andersen, PhD. “This has been attributed to the effects of sex hormones such as estrogen. But the molecular mechanisms that control this phenomenon are fairly unknown.”

What’s in the genes

To see the ways fat is distributed throughout the body, the researchers analyzed data from the U.K. Biobank -- an international health resource that works to improve the prevention, treatment, and diagnosis of widespread diseases.

Nearly 360,000 participants provided blood samples for genotyping, and the researchers than determined how fat was stored based on the body’s resistance response to an electrical current. While nearly 100 genes were linked to how our bodies store fat, the researchers found that this process affects men and women differently.

“We were struck by the large number of genetic effects that were stronger, or only present, in females,” said researcher Åsa Johansson.

Men were found to have more abdominal fat, whereas women were found to have more fat in their hips, which the researchers attribute to a lower risk for women of developing cardiovascular disease. The converse was found to be true for men, as more fat in the abdominal area has been linked to an increased risk of cardiovascular issues.

The researchers are hoping this study can spur doctors to find new ways to be proactive in helping their patients prevent disease.

“The biological systems we highlight in our study have the potential to be used as points-of-intervention for new drugs that are aimed at improving the distribution of body fat and thereby reducing the risk of disease,” said Rask-Andersen.

Fighting belly fat

As the researchers highlighted in their study, more fat in the belly area is linked to an increased risk of cardiovascular disease. A recent study confirms those findings, and emphasizes that even those of a normal weight that have excess belly fat are at risk for developing heart disease or stroke.

The researchers note that irregular fat distribution puts an extra strain on the heart, regardless of how much the person weighs, and doctors need to be using preventative measures to help their patients.

“General practices [GPs] should proactively look for cardiovascular risk factors so that comprehensive treatment and advice can be given,” said researcher Kornelia Kotseva. “GPs need to go beyond treating the risk factors they know about, and always investigate smoking, obesity, unhealthy diet, physical inactivity, blood pressure, cholesterol, and diabetes.”

If the image of an uncoordinated man in a business suit zipping by on an electric scooter has started to give you anxiety, prepare for a future where the scooter zips by with no person on it at all.

Uber is reportedly planning to test its self-driving technology on scooters and bikes. The news comes courtesy of Chris Anderson, the CEO of a robotics engineering firm.

Anderson tweeted from a robotics conference this weekend that Uber announced plans to merge self-driving technology with microbility.

Uber last year acquired e-scooter and e-bike company Jump, the division that its new Microbility Robotics team would work under. Uber has already begun hiring for the team, the Telegraph newspaper is reporting.

According to Anderson, the purpose of adding autonomy to scooters and bikes would be to allow the devices to drive themselves to charging stations “or better locations.”

Custom Made Meals of Denver, Colo., is recalling approximately 7,954 pounds of chicken skewers.

The product contains coconut, a tree nut allergen not declared on the label.

There have been no confirmed reports of adverse reactions.

The following item, produced from September 27, 2018, through January 10, 2019, is being recalled:

• 9.11-lbs. cases containing four plastic packages of “Red Chili Orange Chicken Skewers” with case code 79073, and various Use By dates between Oct. 15, 2018 and Jan. 28, 2019.

The recalled product, bearing establishment number “P-4121A” inside the USDA mark of inspection, was shipped to retail locations in Illinois and Wisconsin and donated to organizations in Denver.

What to do

Customers who purchased the recalled product should not consume it, but discard it or return it to the place of purchase.

Consumers with questions about the recall may contact John Birdsall at (303) 204-7475.

Prinston Pharmaceutical, doing business as Solco Healthcare, is recalling one lot of Irbesartan and seven lots of Irbesartan HCTZ tablets.

The products contain a trace amount of N- nitrosodiethylamine (NDEA) above the acceptable daily intake levels released by the FDA. NDEA has been classified as a probable human carcinogen by the International Agency for Research on Cancer.

Prinston Pharmaceutical has not received any reports of adverse events related to this recall to date.

The following products, used to control high blood pressure and for the treatment of heart failure, are being recalled:

The recalled product, which can be identified by checking the product name, manufacturer details and batch or lot number on the bottle, were distributed nationwide.

What to do

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication. Patients who are on Irbesartan should continue taking their medication, until their pharmacist provides a replacement, or their doctor prescribes a different medication that treats the same condition. The risk of harm to a patient’s health may be higher if the treatment is stopped immediately without any alternative treatment.

For a return label, consumers may contact the company at (609) 451-1000 or by email at customerservice@solcohealthcare.com.

During the height of the opioid epidemic, over a period of less than two years, doctors accepted nearly 435,000 payments from Big Pharma, according to a new study that found an association between the payments and higher opioid deaths.

The study, published in the JAMA open network, reviewed Big Pharma payments that were made to doctors between August 2013 and December 2015, totaling $39.7 million.

The payments may have been relatively small in some cases, as they didn’t include research payments. Instead, the estimated 67,500 doctors who received the money were getting treated to free meals, travel costs, speaking fees, and consulting fees. But those marketing efforts may have still had a damaging effect on public health.

When adjusting for “socio-demographic factors,” the researchers found that every additional marketing dollar was associated with an increase in opioid-related deaths.

In one county of 100,000 people, three additional payments made to doctors over the study period correlated with 18 percent more opioid-related deaths, the study says.

“Amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted,” the authors conclude.

The study cautions that confirming a definitive link between pharmaceutical payments and opioid deaths still requires more research. But numerous lawsuits and investigative reports have documented how Purdue Pharmaceuticals aggressively marketed opioids to doctors shortly before the opioid epidemic hit the United States.

“I don't think they initially really recognized it was causing addiction, but over time they certainly knew it,” Dr. Marvin Seppala, the chief medical officer of the Hazelden-Betty Ford center, told ConsumerAffairs last year, speaking about the efforts that the industry made in marketing opioid drugs to doctors.

Dr. Magdalena Cerda, a professor at the NYU School of Medicine, told Stat News that the latest research findings “suggest what matters is not so much the high value of payments to a few doctors, but the low value of payments to many doctors, for such things as meals.”

In the midst of all of the Trump administration’s tugs-of-war that have consumed 2019 so far, the White House has released the final rules for a new business tax deduction -- one it’s had in the works for nearly two years.

The final regulations were a key component of the Tax Cuts and Jobs Act -- one which allows owners of sole proprietorships, partnerships, trusts, and S corporations to deduct up to 20 percent of their qualified business income.

The Treasury crows that “the final regulations ensure that this historic tax cut will be available to the broadest spectrum of American businesses,” but as tax plans go, there are always winners and losers.

On the winning side of the new plan are rental real estate owners, assisted living facilities, and employment staffing companies. On the losing side are real-estate settlement agents, major league sports team owners, physical therapists, and writers -- all given the thumbs-down from the Treasury Department.

But the big winner are small and medium-size business owners who will enjoy a new 20 percent tax deduction plum. Administration officials said the new rules give the green light to millions of businesses to file their 2018 taxes with the confidence they’re eligible for the break.

“Small and mid-size businesses are the engines of growth for the U.S. economy,” said Secretary Steven T. Mnuchin. “The pass-through deduction will drive more investment in U.S. companies and higher wages for American workers. This provision will reduce pass-through business tax rates to their lowest rate in more than 80 years.”

17-40 million will enjoy the deduction

The Treasury Department estimates that the number of U.S. business owners lucky enough to get the 20 percent break runs somewhere between 17 and 40 million. As things stand now, the deduction is available to small business owners with income below $315,000 for married couples filing jointly and $157,500 for single filers without limitations.

For business owners above those income thresholds, the regulations are a bit tighter. However, the architects of the plan have built in some flexibility for those who can “provide certainty and flexibility by clarifying the definitions of ‘specified service trade or business’ and ‘unadjusted basis immediately after acquisition’ of qualified property, and by including ‘aggregation rules’ for filers with pass-through income from multiple sources.”

That’s a mouthful -- and a confusing one at that. ConsumerAffairs asked Nicole Kaeding, director of federal projects at the Tax Foundation, for an easier-to-understand version.

“Because the deduction is so generous, the Treasury is simply putting ‘guardrails’ on them so individuals don’t abuse the privilege,” Keading said.

How those “guardrails” shake out could be a problem, though. Keading told the New York Times that the regulations would likely lead to lawsuits that force courts to determine whether many individual businesses qualify.

The Food and Drug Administration (FDA) is continuing to voice its concern on the alarming rise in e-cigarette use among teens.

Over the weekend, Commissioner Scott Gottlieb -- who has repeatedly called the surge in teen vaping “an epidemic” -- said that all e-cigarette makers face an “existential threat” if they fail to take sufficient measures to combat youth vaping.

“I still believe e-cigs offer an opportunity for currently addicted adult smokers to transition off cigarettes and onto products that may not have the same level of risks. But if youth use continues to rise, the entire category faces an existential threat,” Gottlieb tweeted on Saturday.

“I believe if every currently addicted adult smoker switched completely to e-cigs it would provide a tremendous public health gain. But that opportunity is in significant risk if kids use continues to rise,” he said.

Need for intervention by manufacturers

During a Friday public hearing on “Eliminating Youth Use of Electronic Cigarette and Other Tobacco Product Use,” Gottlieb noted that the number of teens using e-cigarettes (especially flavored e-cigarettes) has risen dramatically since 2017.

From 2017 to 2018, there was a 78 percent increase in current e-cigarette use among high school students and a 48 percent increase among middle school students, according to the 2018 National Youth Tobacco Survey.

Gottlieb emphasized that there’s a need for makers of e-cigarette products to take measures to mitigate the issue. If companies don’t stop marketing vaping products to youth, Gottlieb said the products could end up being removed from store shelves altogether.

“[I]f the epidemic continues to mount, I’m sure that the debate will change to one of whether these products should continue to be marketed at all without authorized pre-market tobacco applications,” Gottlieb said.

“It could be ‘game over’ for some these products until they can successfully traverse the regulatory process. I think the stakes are that high. And would be a blow for all of the currently addicted adult smokers who, I believe, could potentially benefit from these products,” he said.

Juul reacts

The FDA has previously singled out Juul for its significant role in the teen vaping epidemic, since underage users tend to gravitate toward flavored products such as those marketed by Juul. However, the company has maintained that it’s doing everything in its power to curb youth use of e-cigarettes.

“Underage use of JUUL and any other vaping products is completely unacceptable to us and is directly opposed to our mission of eliminating cigarettes by offering existing adult smokers a true alternative to combustible cigarettes," said Ted Kwong, a Juul Labs spokesperson.

"We are moving full steam ahead on implementing our action plan to limit youth usage, and this is unchanged since we announced our plan in November," he added. "We will be a transparent, engaged, and committed partner with FDA, state Attorneys General, local municipalities, and community organizations in the effort to combat underage use.”

Juul announced in November that it planned to pull some of its flavored pods from retail stores, shutter several of its social media accounts, and introduce stricter age-verification tools on its website as part of its effort to reduce youth use of its products.

In 2015, Turing Pharmaceuticals became the target of public rage when it purchased an old drug, Daraprim, and immediately raised the price of the drug from $13.50 a tablet to $750 a pill.

It turns out that might not have been an isolated example.

Researchers at the University of Pittsburgh found that new drugs entering the market do tend to push the average cost of a prescription higher, but drug companies are also hiking the price of older medications.

In fact, in their study published in the January issue of Health Affairs, the researchers suggest older, existing drugs account for most of the overall increase in the cost of prescription drugs.

“It makes sense to pay more for new drugs because sometimes new drugs are more effective, safer or treat a new disease you didn’t have a treatment for,” said Inmaculada Hernandez, Ph.D., an assistant professor at Pitt and lead author of the study. “But the high year-over-year increases in costs of existing products do not reflect improved value.”

Same drug, higher price

In other words, consumers are paying more for drugs -- sometimes a lot more -- but it’s the same drug as before. It hasn’t changed and it’s not in any way “new and improved.”

The researchers found these existing drugs increased in price about 9 percent each year, nearly five times the rate of inflation. The price of brand name injectables rose nearly twice as much.

A case in point is Sanofi’s Lantus brand insulin, which had increased in price by 49 percent in 2014. At the time, Lantus had been on the market for more than a decade.

“These types of insulin have been around for a while,” Hernandez said. “Whereas the original patent for Lantus expired in 2015, dozens of secondary patents prevent competition, and it is this lack of competition that allows manufacturers to keep increasing prices much faster than inflation.”

Looking out for shareholders

Another factor may also be at work. Last year, Nirmal Mulye, CEO of a small pharmaceutical company called Nostrum, raised eyebrows when he defended his company's decision to raise the price of nitrofurantoin from $474.75 to $2,392. Nitrofurantoin is a drug that is highly effective at treating lower urinary tract infections.

In an interview with the Financial Times, Mulye noted that one of his competitors had just raised the price on a similar drug by a similar amount.

“I think it is a moral requirement to make money when you can . . . to sell the product for the highest price,” Mulye told the publication.

The price of prescription medication is one issue on which both Democrats and the White House may find common ground. Then-candidate Donald Trump was vocal in his criticism of drug companies during the 2016 presidential campaign, and he has continued to call out individual pharmaceutical companies during his presidency.