Acne Treatment – Past to Present

The first acne treatments developed by Dermatologists, way back in the 1800s, differ little from some over-the-counter medications you can pick up today in almost any drugstore. Sulfur was used, along with other irritants, to dry out the skin causing the blemish to peel and loosen impaction in clogged pores.

By the 1940’s and 1950’s drying lotions included anti-bacterial ingredients along with sulfur. The main problem with sulfur was that, although it did get results, it normally tended to lose efficacy with prolonged use. It’s been shown that the skin quickly adjust to the active ingredients.

It wasn’t until the use of the first antibiotic, penicillin, in acne medications that more effective antibacterial treatments came into use. However, penicillin turned out to have very little effect on acne, although it would circulate in the bloodstream it would not get into the skin. Fortunately, other antibiotics were discovered (namely tetracycline) that did penetrate into the skin. This medication, along with clindamycin and erythromycin became the preferred acne treatment for several decades.

Benzoyl peroxide has been in use for the treatment of acne since the 1920’s when it’s treatment efficacy was discovered by Jack Breitbart of Revlon laboratories. It became available as both an over-the-counter treatment and through prescription (at higher strengths). Its long lasting popularity is credited to its antibacterial properties and its affects as a peeling agent. Benzoyl peroxide also limited the secretion of certain oils that contained fatty acids known to contribute to acne flare-ups.

Vitamin A acid (Retin-A) was developed in the late 60’s and became another important acne treatment when it came to the market in the early 1970s. Vitamin A helps acne by normalizing exfoliation inside the follicle which helps to reduce the formation of blackheads, whiteheads and other acne lesions. However, many patients have experienced significant swelling and redness in the first few weeks of use, this causes some patients to stop using it.

This has been a problem with many traditional acne treatments, they can cause extreme irritation and are proinflammatory. It seems contradictory that the cure is similar to the problem – both were inflammatory.

Building on the discovery of vitamin A, the retinoic acid derivative isotretinoin was released in 1982. Known by the trade name Accutane it has been proven effective for the treatment of an extreme form of acne known as cystic or nodular acne. It is normally taken over a 20 week course and for those affected by severe cases it has proven nothing short of a miracle. However, it has a number of possible severe side effects such as: a sudden inability to see at night (so night driving can be dangerous), intra-cranial pressure, inflammation of the liver and severe birth defects.

Oral contraceptives have also proven effective for women with acne. They work by normalizing hormonal surges that can cause acne.

Alpha hydroxy acids, such as glycolic acid and citric acid are other over-the-counter acne treatments. They proved effective at increasing the shedding of skin cells, this helps to clear out blocked follicles. They are also popular for their antibacterial and anti-inflammatory properties.

In addition to these, acne patients have been subjected to some other unusual treatments in search of a cure. Over 50years ago X-ray was used by German physicians to treat their acne patients. It was considered extremely effective at drying up the oil glands, it was even used to remove facial hair. Fast forward to today and this therapy, used on many thousands of patients, is known to have caused multiple skin cancers and cancer of the thyroid in these patients from the radiation.

Where Are the Best Hospitals in Sao Paulo, Brazil?

São Paulo is the largest city in Brazil and world’s 7th largest metropolitan area. This Alpha World City with many tourist hot spots is the second most populous metropolitan area in the Americas. This prominent commercial and entertainment center has a famous nickname “Sampa”.

São Paulo has a large number of well-equipped hospitals that offer health care service of international standard. Its private health care sector is very large with many world-class hospitals and most of the major hospitals in the nation are situated in São Paulo. All these leading hospitals in São Paulo offer service of English speaking staff.

Here is a short description of some of the leading hospitals in São Paulo.

The Hospital Alemão Oswaldo Cruz (Oswaldo Cruz German Hospital) situated at RuaJoaoJuliao,331-Paraiso CEP 01323-903- Sao Paulo is a prominent hospital in Brazil with international reputation. This 239-bedded hospital was founded in 1897 by a group of German immigrants. This Joint Commission International (JCI) accredited hospital has also achieved TEMOS, Telemedicine for the Mobile Society, certification. This famous German agency has given top marks to Hospital Alemão Oswaldo Cruz for providing best health care service to Europeans visiting Brazil. By conducting many highly complex surgeries, the hospital has attained the highest-level certification from Brazilian Accreditation Organization (ONA) also. The hospital has 239 beds, 13 ICU beds, 13-operation theaters with4 laminate flow system, sterilized materials store, equipment room, a best equipped emergency room and 15 PRA (Post Anesthesia Recovery) beds. The hospital offers excellent clinical, diagnostic and surgical service in different departments including cardiology, imaging diagnosis, endoscopy, memory stimulation, metabolic surgery, nephrology and dialysis, orthopedics, diabetes treatment, Physical therapy, hematology, oncology, human reproduction and transplants. The center offers warm accommodation in a friendly and caring environment. Telephone: 55 11 3549-0093

Hospital Sirio Libanes located at Rua Dona Adma Jafet, 91Bela Vista – São Paulo – S.P.CEP: 01308-060 is one of the most popular, modern hospitals in Brazil and Latin America. This 300-bedded premier health center, established in 1965 has 4,500 employees, performs 50 surgical procedures daily and conducts 2,000 types of various diagnostic examinations. The hospital has achieved international reputation by offering high quality health care service in more than 40 medical specialties and possessing all latest advances in medical technology. They offer medical service of global standard in their various centers of excellence, which include oncology center, cardiology center, diagnostic center, substitute renal therapy, rehabilitation center, urology, gynecology, orthopedics, gastroenterology, magnetic resonance, and memory diagnostic center and their oncology center is particularly acclaimed. The hospital provides fine accommodation in comfortable apartments/suites with an anteroom, cable TV, internet connection, a mini bar, telephone and background music. The hospital started well-equipped and round the clock emergency service with special area for children in 1992 and has modern ICUs with 22 beds for adult patients. This service oriented hospital well known for its patient focused approach is also the most reputed medical education and research institution of the country and has established the famous IEP – Instituto de Ensino e Pesquisa (Teaching and Research Institute).This hospital, a member of Brazilian Healthcare Products and Services, attracts large number of patients from abroad especially from Europe and the United States, accepts many international health plans and has an excellent International relations area with English speaking staff. Phone.: 55 11 3155-0900

Samaritano Hospital São Paulo is another major hospital in Brazil with wide reputation. This is one of the oldest hospitals in the city that came in to existence in 1890. The hospital founded by a group of American, of British and German immigrants had a modest start and then grew considerably to become a JCI accredited, modern health care center of international standard. This 200-bedded hospital offers complete and effective medical and surgical service in various departments like cardiology, neurology, pediatrics, orthopedics, gynecology, neonatology, oncology, urology and emergency procedures. More than 1100 physicians and surgeons are practicing here and the hospital’s surgery section has achieved wide recognition for carrying out high complex surgeries and video-assisted surgeries. Samaritano Hospital is a popular center for epileptic surgery, plastic surgery and cochlear implants. This hospital well known for its advanced technology and best personal care has special facilities for international patients. The hospital offers excellent accommodation in large private rooms with comfortable bathrooms, phone, internet, automatic safe box and cable TV. The customer care section assures best service in hotel booking, bus and air ticketing, translation, foreign exchange, laundry, valet parking etc. Cafeteria and restaurant with various delicious dishes are also provided in the premise. Phone: (+55) 11-3821-5300

Where Can You Buy Amberen?

Amberen, the product designed for menopause relief, works to help your body adjust to the changes which every woman goes through during menopause. Having said this, many women are not sure where to buy Amberen. In this article I will look at the different options which are available to you when buying Amberen and find out which one is right for you.

The first place that many people look to buy such products is the store or chemist. Unfortunately, Amberen is not available in many stores and it will not be easy to find one which sells it. Furthermore, due to the fact that such a small number of stores sell it, they are able to charge quite a premium and it will not be good value.

The next place you might want to look at are some of the approved online Amberen distributors out there. There are quite a few websites which sell the product online but we do not really recommend them. Firstly, it is likely to cost more as once again it is quite hard to find. More importantly, however, it can be hard to send it back if it does not work for you which is essential in the case of Amberen.

In my opinion, it is best if you go for the Amberen free trial. With the trial you will be able to see whether or not it works for you and decide whether or not you want to continue with the medication. It is worth bearing in mind that for some women Amberen will not work and might provoke some side effects. So go for the free trial and if it does not work, you can always send it back before being charged anything.

The Criteria For Selecting Medication For A Patient

SINCE World War II, medical science has progressed to a stage where competitive medications are available to treat the same ailment in different people. This is not just about brands (which is a trade issue) but generic drugs (which is a scientific issue). In this report, we shall look at the various factors that decide the selection of a particular drug.

Safety: The following sub-criteria must be considered under the criterion of safety:

* Acute therapeutic index: If the patient’s condition is acute, how effective is a particular drug even if it has certain side-effects as long as the acuteness of the condition is lowered? Example: narcotic pain-killers are very effective in healing pain but come with the potential side-effect of addiction.

* Long-term safety: A medication may be safe in short-term treatment, but how safe it is in long-term treatment? Example: antibiotics are acceptable in short-term treatment, but can have undesirable effects in case of prolonged use.

* Drug-drug interaction risk: Drugs are chemicals, and many chemicals react to produce a different chemical, which has an effect that may harm the patient or aggravate his/her condition. Example: A tricyclic anti-depressant and alcohol interact to produce a new condition that warrants separate treatment.

Drug-drug interaction risk is of two types:

· Pharmacokinetic: In this type of drug-drug interaction, two drugs, independent of each other, have certain effects on one or more body processes (e.g., metabolism) that affects the performance of the other. Example: Darvocet-N (propoxyphene and acetaminophen) inhibits the action of a liver enzyme that Lexapro (escitalopram) depends on for its metabolism. This causes an increase in the side-effects of Lexapro.

· Pharmacodynamic: Here, two or more drugs actually produce the same effect on the same organ, thus increasing the total, added effect. Example: Lexapro has certain side-effects such as drowsiness and fatigue. Darvocet-N also acts similarly on the brain. Thus, the side-effects of both the drugs are more intense.

Tolerability: A drug may be effective but not tolerable by all patients. Example: Allergies to certain drugs in some people. Short-term and long-term tolerability have to be taken into account. Efficacy: A drug is not equally effective in all patients. For example, some patients with depression or anxiety disorders experience relief from escitalopram, but there are many who don’t, who therefore have to be prescribed a different anti-depressant. The rate of onset of therapeutic action is an important factor to be considered too.

Cost: Cost does not mean the cost of purchase of a certain medicine alone. It should also cover the cost of treatment of a complication that may arise from using a different drug. Example: In a person who insists on taking alcohol and yet needs to be treated for depression is usually administered an SSRI drug because these drugs don’t potentiate the effects of alcohol, whereas another group of anti-depressants (such as tricyclics) can cause a new problem in such patients, which would require a different and expensive treatment. Therefore, it’s better to prescribe the more expensive escitalopram instead of a cheaper tricyclic in such patients.

Simplicity of treatment: The simplest mode of administration is preferred. If there is a choice between an injection and oral administration, the latter is preferred if the efficacy of both the modes is comparable. Or, local application is preferred to the oral route where possible; e.g., antibiotic treatment of eye infections. Dosage and frequency of administration too are an important factor to decide simplicity of treatment.

To summarize, not all medicines with the same composition are equally effective on all patients with the same ailment. Safety, tolerability, efficacy, cost, and simplicity are the issues to be considered. Most doctors go by their own experience with past patients and change prescription only if it is not working on specific patients. This is because it is not possible (or too cumbersome) to perform tests to judge the suitability of specific drugs on each patient before prescribing, though such tests are performed in cases where incompatibility can lead to very serious side-effects.

Combat Pseudo Gout With Homeopathic Treatment

Pseudo gout is a medical condition which is often mistaken for the condition to be as gout. The symptoms are very similar to each other and that is the reason why it is termed as pseudo gout. But the medical name of the disease is Calcium Pyrophosphate Deposition Disease which is sort of a rheumatologic disorder. The main cause of the disease is the buildup of calcium pyrophosphate dihhydrate crystals in the connective tissues of the body.

The main symptoms of the pseudo gout are very similar to the symptoms of the gout. Acute and unbearable pain, swollen joints, redness and warmness are the symptoms of the disease. The treatment of the pseudo gout is mainly focused on the prevention of buildup of more crystals in the joints but managing the pain is yet another challenge before the doctors.

Just like the gout attack, the doctors offer conventional treatment option for the problem of pseudo gout. Homeopathy is another alternative medication option for pseudo gout. The Homeopathic therapy does not based on the matter of diagnosis rather it depends on the specific nature of the symptoms. The best thing about the homeopathy is that they are safer, free from any side effects and inexpensive too. Different types of homeopathic medications can be used for the treatment of the pseudo gout. Good thing is that you can even try these out alongside the conventional medicines. However, you should always consult with your doctor before you try the homeopathy medications.

Here are some helpful homeopathic that offer treatment to the patients of pseudo gout.

Rhus Tox

This homeopathic medicine is mainly used for managing the acute pain felt in the pseudo gout. This is good for the pain that gets worse after you walk the first few steps after a long rest and decreases when you move for a while. This medication is good for the morning stiffness problems. This is also good for the patients who suffer the sensitivity problem in wet and cold weather. This works fine with the night pain too.

Bryonia

This medicine is good for the extreme pain felt after you have walked for some time. When the pain is severe and acute after some activity Bryonia is the perfect solution.

Apis

The medicine is good for the swelling pain in the joints. Inflammation and burning pain I cured by the medicine. This is good for the pain which aggravates by hot compresses and decreases by cold water.

Belladonna

This is good for the swelling, acute pain, redness and hot feeling around the joint areas. If the joints ache is there with slight motion or touch you can use Belladonna to control the pain.

Ruta

If your joint pain starts in any joint area where you have once any injury then this is the right medicine for you. The pain may worse in the morning and get worse by motion and cold.

Kalmia

This medicine is good for the sudden onset of joint paint that moves from one joint to other joints. This will help in reducing the pain.

These are the homeopathic medicines that can be used effectively for treating the pseudo gout problem.

Replenish Nutrients Lost Through Alcohol Consumption

You had a wonderful weekend, but now you feel lazy, sapped of energy, and unable to concentrate. It’s because the alcoholic beverages you drank filled you up with empty calories and left you sapped of nutrients. For this reason, it is important to take vitamins and nutritional supplements to replenish nutrients lost through alcohol consumption.

Alcohol Consumption and Vitamin Depletion

Many of us spend our weekends enjoying ourselves, and the Monday blues set in by Sunday evening. Although it’s fun to release stress and tension by drinking socially, it is important to realize that excessive alcohol consumption can result in adverse side effects like vitamin depletion. When drinking socially, it’s easy to forget to eat properly. People often end up either not eating anything, or munching on popcorn or peanuts. This results in the intake of empty calories, which do nothing to nourish the body. The result? A body depleted of essential vitamins and minerals, which are important in maintaining good health. Heavy drinkers generally suffer from deficiencies of vitamin B, vitamin B1 or thiamine, vitamin C, vitamin A and folic acid. Our body requires these essential vitamins, minerals, and nutrients in order to protect our organs and promote optimal functioning of our entire body. If a person does not eat enough of these vitamins and nutrients, his or her health will deteriorate.

Drink, And Still Stay Healthy

Although it is difficult to give up drinking, here are a few tips to help you ease your way into a healthier lifestyle.

  • Drink in Moderation: Excessive alcohol intake can be very harmful; it is for this reason that doctors advise drinking in moderation. One drink a day for anyone above 65 and 2 drinks a day for men under 65 is considered moderate drinking.
  • Maintain a Healthy Diet: A healthy diet and regular exercise can ensure that your body remains healthy, even while drinking occasionally. Therefore, eating a diet rich in green leafy vegetables and fruits is a good idea. Vegetables are a rich source of vitamins and nutrients. You can also include dairy products, eggs, fish, liver, wheat germ, wholegrain products, and chicken in your diet. Avoiding junk food – especially fried fast food – can work wonders for your health. By balancing your diet according to these steps, you can help replenish vitamins and nutrients lost due to excessive drinking.
  • Take Custom Vitamins for Drinkers: Investing in custom vitamins could certainly work for you. Since these vitamins nutritional supplements are customized and prepared by taking into account your individual body composition, the chance of vitamin overdose or under-dose occurring is slim. Customized nutritional supplements are the best way to ensure that your body does not suffer much due to alcohol intake. Therefore, custom vitamins are a nearly surefire way to ensure that your body gets what it needs to stay healthy – even as you continue to drink moderately. For people who find it difficult to give up drinking entirely, but would like to improve their health, these tips can definitely help.

Navigate Your Way to Proper Internal-External Hemorrhoid Coding

Do not miss CPT 2010 ‘either/or’ instruction for hemorrhoid location.

You cannot select a hemorrhoidectomy code if you do not know the distinction between internal and external hemorrhoids. Let our experts take you through the anatomy and coding maze to help you select the right code.

Location should guide you

According to Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPCP, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program, “External hemorrhoids occur outside the ‘anal verge,’ which is at the distal end of the anal canal.”

On the other hand, “internal hemorrhoids are proximal to the anal verge and can be much tougher to diagnose and treat,” she carries on.

Important to identifying different hemorrhoid types is… the dentate line. The line is a mucocutaneous junction about a cm above the anal verge, and “can be seen separating the anus from the rectum,” says Suzan Berman, CPC, CEMC, CEDC, senior manager of coding and compliance in the surgery and anesthesiology departments at the University of Pittsburgh Medical Center. Internal hemorrhoids take place above the dentate line, and external hemorrhoids occur below the line.

Best option: Knowing the lingo might help you translate op notes, however having your physician indicate “internal” or “external” will bring down any potential coding mistakes.

Look for ‘Internal’ Excision Instruction

Lack of specific internal hemorrhoid excision codes can be perplexing.

For example: “The only code I can come up with the excision of one internal hemorrhoid is the unlisted code 46999 (Unlisted procedure, anus),” according to Sandra Sickler CPC, CCS, coder with Countryside Surgery Center in Clearwater, Fla.

Here’s a solution: By adding the following text note, this year’s CPT codes allow you to utilize certain codes for internal and/or external hemorrhoids: “For excision of internal and/or external hemorrhoid(s), look at 46250-46262, 46320.” That means you can use 46255 (Hemorrhoidectomy, internal and external, single column/group) for the excision of one internal hemorrhoid (or 46260 [… 2 or more columns/groups] for excision of multiple internal hemorrhoids), according to Bucknam.

You might go for 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group) or 46946 (… 2 or more hemorrhoid columns/groups) for certain internal hemorrhoid excisions, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta. Called “transfixion suture excision”, the surgeon places a crisscross stitch and ties off the base of the hemorrhoid with the suture (ligation) to be in charge of bleeding. Then the surgeon excises and does away with the remaining hemorrhoid.

One more problem: Your surgeon might excise a thrombosed internal hemorrhoid, however 46320 (Excision of thrombosed hemorrhoid, external) describes an external hemorrhoid procedure. Based on the new text note for internal and/or external codes, you can report 46320 for internal hemorrhoids, says Bucknam.

Follow ‘External’ Rules for the Right Code Choice

Even though the new text note for internal and/or external codes might seem to allow 46255 for a single external hemorrhoid, a separate text note following 46250 directs, “for hemorrhoidectomy, external, single column/group, go for 46999.”

Likewise, for excision of multiple external hemorrhoids you should make use of the most specific code 46250 (Hemorrhoidectomy, external, 2 or more columns/groups) rather than 46260.

Look at ‘Internal and External’ Codes for ‘Mixed’ Removals

Your surgeon may excise a “mixed” or confluent hemorrhoid that starts above the dentate line and extends below it. These hemorrhoids show attributes of both an external and internal hemorrhoid. You can find out what codes you should select by subscribing to the General Surgery Coding Alert.

Is Red Clover a Good Gout Herbal Medicine?

Red clover has been used traditionally as gout herbal medicine for centuries due to its ability to remove toxins from the body. However, using red clover isn’t without its side effects. Scientists are now seeing that red clover thins the blood, so it should not be taken without the guidance of a doctor or other health professional. If you are already on anticoagulant medicine, red clover should not be used.

The properties within red clover that make it an effective gout herbal medicine are isoflavones. The isoflavones levels in red clover are 100 times higher than those of soy. This helps to heal inflammatory conditions, including gout, but also arthritis and eczema.

As a herbal medicine, red clover is also known as:

– Meadow clover

– Cow clover

– Purple clover

– Trifolium pratense (Latin name)

– Trefoil

– Wild clover

Red cover belongs to the pea family. It helps with the elimination of uric acid, which is important to the treatment of gout, since symptoms are a result of a buildup of uric acid causing crystal formation on the joints. Therefore, as red clover helps to eliminate levels of uric acid in the blood, the body has a reduced chance of experiencing a build up of uric acid therefore, reducing the likelihood of a gout attack.

Before taking red clover, be sure to speak to your health specialist, as you should before taking any new herb or supplement. As a gout herbal medicine, red clover is available in many different forms. These include:

– Teas

– Tinctures

– Capsules

– Tablets

– Liquid extracts

– Isoflaven standardized extracts

– Topical ointments

When taken as tea, simply use one to two teaspoons of dried red clover flowers in a mug (8 ounces) of hot water; two to three cups should be taken daily. Or, red clover extract can be mixed into a regular cup of tea.

Red clover in capsule form is usually taken in doses of 50mg to 150mg daily. If the capsules are red clover isoflavone extracts, then 28mg to 85mg is the normal daily dose. This means that two to three capsules will likely be required. For individual dosage instruction speak to a doctor.

For a direct topical treatment, red clover ointment or cream can be applied directly to the affected area. However, take care not to apply to any area where there is broken skin.

Red clover tincture should be thirty percent alcohol (1:5), and is taken in hot water as a tea with usually between sixty to one hundred drops (3 to 5 mL), three times every day.

Red clover herbal products are available at many natural and herbal stores. It is quite a common item so should be available in several forms at your local health shop.

Be aware of the possible side effects of gout herbal medicine made with red clover. General side effects can include nausea, headache, and rash. Infertility has also been witnessed in animals that graze on red clover patches. For more information please speak to a health professional.

10 Advantages of Light Therapy

Weakness and disease are inescapable facts of life. You could fall prey to a pathogenic bacterium that could eat away your skin. You could catch a deadly virus that could lodge in and weaken your lungs. You could be sick because of sunlight, or you could be sick because of depression related to the weather.

Sickness is inevitable, but suffering is optional. There are many therapies available to cure sickness, or to alleviate the pain of its symptoms. You can take medicines or be injected with them. These medicines are engineered in the laboratory to destroy infectious agents by either breaking open their cell walls, or targeting pathogenesis-related genes in their genetic material.

You can also be given vaccines to protect you from future infections. Vaccines are actually a mild version of the pathogen, and mimic the presence of the pathogen in your body. It is this mimicry that, in turn, triggers a mild immune response, which leads to your body producing cells that will keep you from succumbing to infections when you grow older.

Surgery is the last resort when trying to cure a disease. Parts of damaged organs can be removed, so that they do no further harm to the body. Whole organs may also be transplanted into you to ease the body of its burden of trying to use an organ destroyed by pathogens. You may be fitted with prosthetics, given chemical treatments, or tumors can be taken away for biopsy.

Thanks to modern technology and discoveries in science, these are not the only ways that diseases can be treated. Laboratory research has found that certain frequencies of light can actually kill pathogens or even rejuvenate cells. As a result, laboratories and clinics now specialize in research and applications in light therapy.

Certain wavelengths of light can have different effects on living organisms. Ultraviolet, or UV light, for example, can destroy bacteria. Lasers can change the configurations of molecules. Alternating periods of light and darkness can cause different plants to fruit or flower, and can change sleep rhythms in humans as well.

Light therapy exploits these properties of light and uses them to create regimens that can help cure, or alleviate the pain brought about by certain diseases. Light therapy can also be used for cosmetic purposes, and is often used in psychiatry to relieve weather-related depression.

Also known as phototherapy, light therapy involves exposing subjects to specific light wavelengths using light emitting diodes (LED), lasers, fluorescent lamps, or bright lights emitting all the colors of the spectrum. Such procedures will be prescribed for a short period of time, and are non-invasive. That is, they will not involve surgery or other penetrating therapeutics, and can thus ease the anxiety of the needle-fearing, scalpel-phobic patient.

What are the advantages of using light therapy?

– Light therapy is a non-invasive method that can kill acne-causing bacteria. Acne removal can be painful if done in a dermatologist’s clinic, with only piercing equipment and syringes. Thanks to advances in light therapy, these bacteria can be destroyed when the light penetrates their cell walls, thus stopping them from causing more acne.

– Lack of light, as well as the gray air of winter, can trigger depression. Light therapy can treat depression disorders by giving patients various amounts of light, awakening the brain into thinking that the less gray seasons of summer and spring have come. This prevents patients from taking anti-depression medications, which can have side effects.

– Light therapy can work into the body’s sleep rhythm, or circadian rhythm. Research shows that our sleep habits are governed by light, and light therapy exploits this fact by giving patients varying amounts of light at designated times of the day. This keeps patients from taking tranquilizers to get a good night’s sleep. It can also alleviate the pain of jet lag for frequent travelers.

– Light therapy can treat skin diseases like psoriasis and eczema at a much faster pace than other therapeutics. Ointments and shampoos need months, even years to fully take effect.

– If you are miles away from the beach, but still want to get a tan, you can go to an accredited tanning salon for UV light therapy. At safe doses, UV light can give you the tan that you want without you worrying about overexposure to the sun’s harmful rays.

– Light therapy users claim that light rejuvenates their cells and gives them a more youthful, glowing look. This means less spending on expensive ointments and elixirs promising to turn back the clock on skin.

– Light therapy has been shown to be largely effective for at least ninety percent of patients.

– Light therapy can be done at home, with special light boxes. Although expensive, rising demand can lower the prices of such light boxes.

– When done with the supervision of experts, light therapy can be controlled, and its effects monitored accordingly. That is, the amount of light, its intensity, and frequency can be measured and adjusted easily.

– Light therapy is safe for many patients, if placed under the control and supervision of accredited experts.

If you think that light therapy is for you, consult with your doctor, and find out what clinics are accredited and certified in your area. If you fear needles and scalpels, but want to get cured and get better, then light therapy might just be the answer you are looking for.

How to Exploit a Woman’s Mind And Turn Her Into Your LOVE SLAVE Who is Addicted to You Forever!

If you are scared about using highly covert (but not illegal or unethical) ways to seduce and attract women, then turn away now. These tactics are definitely not for those who are faint-hearted! On the other hand, if you have got the guts to use these techniques, then success with women would come easy to you. All you need to do is to learn these tactics and techniques – and most importantly, use them! When you do this, you would be able to make any woman totally addicted to you and want to be your LOVE SLAVE for life…

How To Exploit A Woman’s Mind – And Turn Her Into Your LOVE SLAVE Who Is Addicted To You Forever!

“Play The Game Of Rejection”. Look – one thing that a beautiful woman NEVER gets is rejection. If you want to stand out in the mind of a perfect 10, then you have got to do the unexpected – REJECT HER. Most guys would try to kiss her proverbial behind in order to impress her – but you should not do the same unless you want to be seen as one of them losers. You should instead play “hard to get” – and her beauty should leave you unfazed.

“Make Her Qualify Herself”. This is a killer mind trick that would really mess her up. Ask her to give you reasons she should get YOUR attention. Turn the tables on her and make her qualify herself to you. This is a reverse psychology trick which would covertly make a woman feel attracted to you.

What Women Should Know About Cervical Cancer & HPV

Cervical cancer is a malignant cancer tissue that attack cervix (organ connecting the uterus and vagina). There are some types of this cancer. The most common types, the SCC (squalors cell carcinoma), a major cause of cervical cancer with the percentage of 80-85 percent. HPV infection is a “trigger” major in the development of this cancer.

Other types of this cancer, like adenokarsinoma, small cell carcinoma, adenosquamos, adenosarcoma, melanoma, and lymphoma, a type of cervical cancer is rarer and generally not associated with HPV. Various types of cervical cancer this last can not be prevented, such as SCC.

Signs and Symptoms

Early stage cervical cancer are asymptomatic.

Advanced cervical cancer showed symptoms of vaginal bleeding, back pain, urinary symptoms such as dyisuria (painful or difficult urination) and cloudy urine, and digestive disorders such as chronic constipation and tenemus (still feel a lump, although it has a bowel movement).

In addition, pain-is when sexual intercourse and vaginal discharge is also a symptom of advanced cervical cancer. Less common symptoms include loss of appetite, weight loss, fatigue, leg pain, leg swelling, and leaking urine or feces from the vagina.

Carcinoma in Situ (CIS or CIN)

Pap smear can identify carcinoma in situ (CIN) in cervical, and treatment can prevent cancer development. CIN is a cluster of pre-malignant cells is still the “in situ” or “in place” and did not move from its initial position and not spread to other parts of the body. Thankfully, in Singapore and other developed countries, the use of cervical scanning program has reduced the number of invasive cervical cancer sufferers.

Women are encouraged to perform a Pap smear once a year since their first sexual intercourse and continued until they were aged about 70 years. If two to three years Pap smear results are normal results, women may decide to reduce the frequency to two to three years. However, high-risk women (see below) are encouraged to continue it every year.

Not all women with HPV infection to patients with CIN, and not all women with CIN to cervical cancer sufferers. Many HPV infections disappear quickly countered by the immune system, just like any other infection.

However, certain types of HPV in the cervix tend to settle for a few years, genetic change cells making the cervix, and causes dysplasia (abnormal cell growth). If not treated immediately, severe dysplasia can and usually will develop into invasive cervical cancer.

CIN usually do not show any symptoms. This is a good time to scan the treatment of cancer because it was nearly always result in complete recovery.

People at Risk

All women who engaged in risky sexual be cervical cancer sufferers. However, women who have many male friends to have sex (or her male friend had been having a lot of female friends for sex) higher risk. Women who began having sexual intercourse before age 16 without a safety in the highest risk.

Has developed an effective vaccine against HPV types cause 70-85% of all cervical cancers.

HPV vaccine is for girls and women aged 9-26 years because the vaccine only works if given before infection occurs. However, this vaccine can be given to women remains a rather late start of sexual activity. Prices are expensive vaccines sometimes cause reluctance. However, because this vaccine only covers for certain high-risk HPV types, women have Pap smears regularly, even after vaccination.

Diagnosis

Although the Pap smear test is an effective scanning of this cancer, confirming the diagnosis of cervical cancer or pre-cervical cancer requires a biopsy. This is often done through colposcopy, a visual examination of the cervix with a magnifying tool, assisted acid solution to highlight abnormal cells on the surface of the cervix. This is an outpatient procedure for 15 minutes and not causes pain.

Further diagnostic procedures include LEEP (Loop Electrical Excision Procedure), cone biopsy (cone biopsies), and punch biopsies.

Stadium and Treatment

Federation of Gynecology and Obstetrics (FIGO) cervical cancer classifications based on scanning into CIN I to CIN III, with CIN III is the direct precursor to cervical cancer. On top of CIN III, meaning has been transformed into cancer cells, and will be classified from stage 0 (cancer confined to the area of skin) to 4B (a relative had spread far).

An early-stage patients can be treated with conservative surgery for women who want to maintain fertility, whereas other patients are usually advised to remove the entire uterus and cervix (trachelectomy). Generally recommended to wait at least one year prior to seeking pregnancy after surgery. Because of the possibility of cancer spread to lymph nodes (lymph node) in a late-stage cancer, the surgeon may also need to lift from the lymph nodes around the uterus for pathologic evaluation.

This cancer is very rare residual cancer has relapsed again if cleaned with the trachelectomy. However, it is recommended for patients to make prevention and treatment continued, including scanning Pap (Pap smear).

Early stage tumors can be treated with radical hysterectomy (removal of uterus) with removal of lymph nodes. Radiation therapy with or without chemotherapy can be given after surgery to reduce the risk of relapse. Early stage tumors can be treated with large radiation therapy and chemotherapy. Furthermore, hysterectomy can be performed for local cancer control them better.

Advanced tumors (stage 2B to 4B) should be treated with combination chemotherapy and radiation therapy.

Survival

With treatment, survival rates of cervical cancer patients after 5 years was 92% for the earliest stages, 80-90% for stage 1 cancer and 50-65% for stage 2. Only 25-35 percent for women with stage 3, and less than 15 percent of fourth stage cervical cancer patients are alive after five years. Therefore, the scanning / screening and early detection of cervical cancer is very important.

Visit the doctor immediately if you experience the following symptoms:

  • Vaginal bleeding
  • Back pain
  • Pain when urinating or difficult urination and cloudy urine
  • Constipation cronies and felt a lump, although defecation
  • Ill-being when having sexual intercourse and vaginal discharge
  • Swollen feet
  • Leaking urine or feces from the vagina

Walgreens, CVS, and Rite Aid – What RE Investors Should Know

There are 3 major drugstore chains in the US: Walgreens, CVS, and Rite Aid. Below are some key statistics about the 3 major drugstore chains as of 2012:

1. Walgreens ranks first with market cap of $28.51 Billion, $72.2 Billion in 2011 total revenue ($45.1B from prescription revenues), and an S&P rating of A. According to Walgreens, 75% of the US population lives within 3 miles from its stores. In April 2010, it acquired 258 Duane Reade drug stores in New York Metropolitan area which brings a total of 7841 drug stores Walgreens operates as of February 2012, including 137 hospital on-site pharmacies.

2. CVS ranks second with market cap of $56.56 Billion, $107.1 Billion in revenue ($40.5 Billion from CVS prescription revenues and $16.1B from its Caremark prescription mail order revenue), and an S&P rating of BBB+. As of December 31, 2011, CVS operates 7404 drug stores.

3. Rite Aid ranks third (fourth, behind Walmart in terms of prescription revenues) with market cap of $1.49 Billion, $26.1 Billion in revenue ($17.1B from prescription revenues), operates 4714 drug stores as of February 2011 and has an S&P rating of B-.

Investors purchase properties occupied by these drugstore chains for the following reasons:

1. The drugstore business is very recession-insensitive. People need medicine when they are sick, regardless of the state of the economy. Both rich and poor people in the US have access to medicine. Some even argue that low-income people use more medicine due to free or low-cost drugs offered by government-assisted programs. So the tenants should do well during tough time and have money to pay rent to landlords.

2. The drugstore business has a good prospect in the US:

· People are living longer and need more medicine to sustain longevity, e.g. Actonel for osteoporosis, Aricept for Alzheimer’s symptoms. Older people tend to use more medicine than younger ones as they often have more medical problems. As the 78 million baby boomers are getting closer to retiring age starting from 2008, the drugstore chains anticipate the demand for medicine to increase in next 20 years.

· The drug market continues to expand as the US population continues to grow. More and more Americans suffer from various diseases. The number of Americans suffers from seasonal allergies doubled in the last 15 years to 37 million people per Fortune magazine. They spent $5.4 Billion in 2009 for allergy drugs. As their waist lines balloon (75% of Americans are forecasted to be either overweight or obese by 2020), more Americans are diagnosed with diabetes, along with high cholesterol at younger and younger ages. In addition, doctors also recommend treating various diseases sooner than later due to better understanding about the diseases. For example, doctors now prescribe antiretroviral drugs for patients soon after infected with HIV virus instead of waiting for the infection to become AIDS. More doctors combine insulin with oral medicines to treat type-2 Diabetes instead of just oral medicines alone. All these factors increase the size of the drug market.

· Advance in genetic engineering has introduced various new genetic DNA testing kits which allow the genetic diagnosis of vulnerabilities to inherited diseases and disorders. Genetic testing is currently the highest growth segment in the diagnostics industry. Some of these genetic tests will probably transform into direct-to-consumer testing kits available in drug stores in the near future.Upon FDA approval, these new products will potentially bring in additional revenue for drug stores.

· Using a new method of tailoring molecules called structure-based design; drug companies come up with new medicines that they might not have discovered otherwise, e.g. Xalkori by Pfizer to treat lung cancer.

· The passage of Health Care Reform Bill on March 23, 2010 provides insurance coverage to an estimated 33 million more American. This is a great present to the drugstore industry.

· There are new drugs to treat previously untreatable illnesses, and new diseases, e.g. Viagra for men’s unhappiness, Avastin for colon cancer, Herceptin for breast cancer,. The new medicines are very expensive, e.g. a year’s supply of Avastin costs about $55,000. Eli Lilly has sold about $4.8 billion of Zyprexa in 2007 for schizophrenia and yet most people have never heard of this medicine.

· There are existing drugs now approved to treat new illnesses and thus increase their sales revenue. For example, Lyrica was originally intended to treat pain caused by nerve damagein people with diabetes. It is now approved by FDA to treat Fibromyalgia which affects 5.8 million Americans per WebMD.

· Big advances in genetics, biology and stem cells research are expected to produce a new class of drugs to treat diabetes, Parkinson’s and various rare genetic disorders. For example the new drug Ilaris from Novartis targets genetic causes of an inherited disorder that there are only 7000 known cases worldwide. However, Novartis hopes to gradually broaden its drugs to a blockbuster drug to more common disorders caused by similar genetics.

· Technology and modern life introduce and require new products, e.g. pregnancy test kits, Lamisil for stronger clearer toe nails, Latisse for longer & thicker eyelashes, Propecia for male hair loss, Premarin for menopausal symptoms, diabetic monitors, electronic toothbrushes, contact lenses, lenses cleaners, diet pills, vitamins, birth-control pills, IUDs, nutrition supplements and Cholesterol-lowering pills (Americans spent nearly $26B in 2006 on Cholesterol medications alone per IMS Health, a Connecticut-based consulting company that monitors pharmaceutical sales.)

· Before the customers can get to the medicine aisles or pharmacy counters, they have to pass by chocolates, sodas, digital cameras, watches, toys, dolls, beers and wines, cosmetics, video games, flowers, fragrances, and greeting cards. Drug stores hope you use the one-hour photos services there. The stores also carry seasonal items, e.g. Halloween costumes, and “As Seen on TV” merchandise, e.g. Shamwow. As a result, customers buy more than their prescriptions and medicine in these drugstores. CVS reported that non-pharmacy sales represented 30% of the company’s total sales in January of 2007. The figure for Walgreens is 34% and 37% for Rite Aid. Many pharmacy locations are in effect convenience stores especially ones that are in residential or rural areas. And so Walgreens hopes that customers also pick up WD-40, and screwdrivers at its stores instead of at Home Depot; Thai Jasmine rice, and fish sauce to avoid a trip to Safeway or Kroger Supermarkets. During the recession, sales of these non-drug items are down as customers buy what they need and not what they want. Walgreens tries to reduce the number of items by 4000. It also introduces its own private label which has higher profit margins.

· There are more and more generic medications on the market as a number of enormously popular brand-name blockbusters lose their 20-year long patents, e.g. Lipitor (best selling drug in the world to lower cholesterol) in 2010, Viagra (you know what it’s for) in 2012. Drugstores prefer to sell generic drugs to customers due to higher profit margins than the brand-name medications.

· Many people are addicted to pain killers, e.g. Hydrocodone/Oxycodone. Per the DEA in 2012, there are 1.5 million American addicted to cocaine but 7 million addicted to prescription drugs.

· This author estimates that at least 10% of the dispensed prescription drugs are not used at all and sit idle in the medicine cabinets. They are eventually expired and thrown away.

3. These companies sign very long-term NNN leases, guaranteed by their corporate assets. This makes the investment in the underlying property fairly low risk, especially for Walgreens with a S&P “A” rating. In fact, these properties are sometimes referred to as investment-grade properties. Once the drugstore chains sign the lease, they pay the rent promptly and timely. This author is not aware of any properties leased by one of these drugstore chains in which the tenants failed to pay rents. Even when the stores are closed due to weak sales (Walgreens closed 119 stores in 2007), these companies may sublease the properties to other companies, e.g. Advance Auto Parts and continue to pay rents on the master leases.

· A typical Walgreens lease consists of 20-25 year primary term plus 8-10 five-year options. During primary term and options, there will be no rent increases in most of the leases. This is the main disadvantage of investing in Walgreens drugstores.

· A typical CVS lease consists of 20-25 year primary term plus 4-5 five-year options. The rent is normally flat during the primary term and then there is a 2.5%-10% rent increase in each 5-year option.

· A typical Rite Aid lease consists of 20-25 year primary term plus 4-8 five-year options. The lease often has a rent increase every 5-10 years.

Investment Risks

Although the pharmacy business in general is recession-insensitive, there are risks involved in your investment:

1) The main downside about investing in pharmacies is there is little or no rent bump for a long time, e.g. 20-50 years, especially for Walgreens. So the rent is effectively reduced after inflation is factored in. This is one of the main reasons these properties do not appeal to younger investors, especially when the cap rate is low.

2) The 3 drugstore chains now have a new formidable competitor, Walmart. Walmart sells prescription drugs in more than 4000 Walmart, Sam’s Club and Neighborhood Market stores in 49 states. As of 2012, Walmart is the third largest drug retailer with $17.4B in prescription sales, just ahead of Rite Aid with $17.1B in prescription sales. The retail giant is known for launching in 2006 a highly-publicized $4 generic prescription drug program which now sells 350 generic medications for a 30-day supply. The actual number of medications is less as the medications with different strengths are counted as different medications. For example, Metformin 500 mg, 850 mg, and 1000 mg are counted as 3 medications. Walmart probably makes very little profits on these medications if any. However, the marketing campaign–created by Bill Simon, the President and CEO of Walmart US, generates a lot of publicity for Walmart. Walmart hopes to draw customers to its stores with other prescriptions where it has higher profit margins. In an unscientific survey with just one brand-name prescription of Lyrica, this author finds the lowest price at Costco, the highest price at Walgreens and Walmart at the middle. Other drug chains try to counter Walmart in different ways. Target now offers the same 350 generic medications for $4 for a 30-day supply. Walgreens has a Prescription drugs club with membership fee which offers 1400 generic medications for as little as $1/week. CVS says it will match any offers from its competitors.

3) Chief Business Correspondent Rick Newman from US World & News Report predicted that Rite Aid might not survive in 2009. Rite Aid is still around in 2012. The prediction seems to go away in 2012 as Rite Aid as it was able to refinance the long terms debts and sales revenue has increased.

4) Drugs are also sold in thousands of supermarkets, Target stores, and Costco warehouses. However, there are no drive-through windows at these stores or Walmart to conveniently drop off the prescriptions and pick up medicines. Customers will not be able to pick up their prescriptions during lunch hour or after 7PM at Target stores or supermarkets. They need to have membership to buy medicines at Costco. Others may not fill their prescriptions at Walmart because they don’t want to mingle with typical Walmart customers who are in lower income brackets. And some baby boomers don’t want their prescriptions filled at Target or Walmart because there are no comfortable chairs for them to sit down and wait for their medicines.

5) Drugs retail business to some degree is controlled by the Pharmacy Benefits Managers (PBMs). Customers normally get prescription coverage from their health insurance companies, e.g. Blue Cross. These PBM manage prescription benefits on behalf of the insurance companies. In 2012 Walgreens lost a contract valued at over $5 Billion with Express Scripts, a major PBM. Walgreen revenue was immediately fallen in the first quarter of 2012 as Express Scripts customers cannot fill their prescriptions at Walgreens. The PBMs are also in the drugs retail business via mail orders which do not require leasing expensive retail spaces. The prescription mail orders currently capture over 20% market share of the total prescription revenue. Should customers change their prescription purchase habits to mail orders (there is no such evidence in 2012), it could have negative impact to the business of drugstore chains.

6) Many leases in areas with hurricanes and tornadoes are NNN leases with the exception of roof and structure. So if the roof is damaged, you will have to pay for the expenses.

7) The tenant may move to a new location down the road or across the street when the lease expires. This risk is high when the property is located in small town where there is low barrier for entry, i.e. lots of vacant & developable land.

8) The tenant may ask for rent concession to improve its bottom line during tough times. The possibility is higher if the tenant is Rite Aid and if the store has low sales revenue and/or higher than market rent.

9) More Americans are walking away from their prescriptions, especially the most expensive brand-name medicines. This may have negative impact on the sales revenue and profits of drug stores and consequently may cause drug store closures. According to Wolters Kluwer Pharma Solution, a health-care data company, nearly 1 in 10 new prescriptions for brand-name drugs were abandoned by people with commercial health plans in 2010. This is up 88% compared to 4 years ago just before the recession began. This trend is driven in part by higher and higher co-pays for brand name drugs as employers are shifting more insurance costs to their employees.

Among 3 drugstore chains, Walgreens and CVS pharmacies in general have the best locations-at major intersections while Rite Aid has less than premium locations. Walgreens tends to hire only the top graduates from pharmacy schools while Rite Aid settles with bottom graduates to save costs. When possible, all drugstore chains try to fill the prescriptions with generic medications which have higher profit margins.

1) Walgreens: the company was founded in 1901 by Charles Walgreen, Sr. in Chicago. While the company has existed for more than 100 years, most stores are only 5-10 years old. This is the best managed company among the three drugstore chains and also among the most admired public companies in the US. The company has been run by executives with proven track records and hires the top graduates from universities. Due to its superior financial strength–S&P A rating– and premium irreplaceable locations, properties with leases from Walgreens get the highest price per square foot and/or the lowest cap rate among the 3 drugstore chains. In addition, Walgreens gets flat rent or very low rent increases for 20 to 60 years. The cap rate is often in the low 5% to 6.5% range in 2012. Investors who buy Walgreens tend to be more mature, i.e. closer to retirement age. They are looking for a safe investment where it’s more important to get the rent check than to get appreciation. They often compare the returns on their Walgreens investment with the lower returns from US treasury bonds or Certificate of Deposits from banks. Walgreens opened many new stores in 2008 and 2009 and thus you see many new Walgreens stores for sale. It will slow down this expansion in 2010 and beyond and focus on renovation of existing stores instead.

2) CVS Pharmacy: CVS Corporation was founded in 1963 in Lowell, MA by Stanley Goldstein, Sidney Goldstein, and Ralph Hoagland. The name CVS stands for “Consumer Value Stores”. As of 2009, CVS has about 6300 stores in the US, mostly through acquisitions. In 2004, CVS bought 1,200 Eckerd Drugstores mostly in Texas and Florida. In 2006, CVS bought 700 Savon and Osco drugstores mostly in Southern California. And in 2008 CVS acquired 521 Longs Drugs stores in California, Hawaii, Nevada and Arizona for $2.9B dollars. The acquisition of Long Drugs appears to be a good one as it CVS did not have any stores in Northern CA and Arizona. Besides, the price also included real estate. It is also bought Caremark, one of the largest PBMs and changed the corporation name to CVS Caremark. When CVS bought 1,200 Eckerd stores, it formed a single-entity LLC (Limited Liability Company) to own each Eckerd store. Each LLC signs the lease with the property owner. In the event of a default, the owner can only legally go after the assets of the LLC and not from any other CVS-owned assets. Although the owner loses the guaranty security from CVS corporate assets, this author is not aware of any incident where CVS closes a store and does not pay rent.

3) Rite-Aid: Rite Aid was founded by Alex Grass (he just passed away on Aug 27, 2009 at the age of 82) and opened its first store in 1962 as “Thrif D Discount Center” in Scranton, Pennsylvania. It officially incorporated as Rite Aid Corporation and went public in 1968. By the time Alex Grassstepped down as the company’s chairman and chief executive officer in 1995, Rite Aid was the nation’s largest drugstore chain in terms of total stores and No. 2 in terms of revenue. His son, Martin Grass, took over but was ousted in 1999 for overstatement of Rite Aid’s earnings in the late 1990s. Rite Aid is now the weakest financially among the 3 drugstore chains. In 2007, Rite-Aid acquired about 1,850 Brooks and Eckerd drugstores, mostly along the East coast to catch up with Walgreens and CVS. In the process, it added a huge long term debt and is the most leveraged drugstore chain based on its market value. The integration of Brooks and Eckerd did not seem to go well. Revenue from some of these stores went down as much as 20% after they change the sign to Rite Aid. In 2009, Rite-Aid had over 4900 stores and over $26 Billion in revenues. The figures went down in 2010 to 4780 stores and $25.53 billion in revenue. On January 21, 2009 Moody’s Investor Services downgraded Rite Aid from “Caa1” to “Caa2”, eight notches below investment grade. Both ratings are “junk” which indicate very high credit risk. Rite Aid contacted a number of its landlords in 2009 trying to get rent concession to improve the bottom line. In June 2009, Rite Aid successfully completed refinancing $1.9 Billion of its debts. In 2012, Rite Aid benefits from Walgreens contract problem with Express Scripts. Same store sales increased 2.2%, 3.2%, and 3.6% for January, February and March of 2012, respectively. Rite Aid is still losing money in fiscal year 2012 which ended in March 3, 2012. However, it is losing less, $0.43 per share in 2012 versus $0.64 per share in fiscal year 2011. The company expects better outlook in fiscal year 2013.

Things to consider when invested in a pharmacy

If you are interested in investing in a property leased by drugstore chains, here are a few things to consider:

1. If you want a low risk investment, go with Walgreens. In stable or growing areas, the degree of safety is the same whether the property is in California where you get a 5.5% cap or Texas where you may get a 6.5% cap. So, there is no significant advantage to invest in properties in California as the property value is based primarily on the cap rate. In 2012, the offered cap rate for Walgreens seems to come down from 7.5%-8.4% in 2009 to 5.5%-6.5% for new stores.

2. If you are willing to take more risk, then go with Rite-Aid. Some properties outside of California may offer up to 9% cap rate in 2012. However, among the 3 drug chains, Rite Aid has 10.5% chance of going under in 2010. Should it declare bankruptcy, Rite Aid has the option to pick and choose which locations to keep open and which locations to terminate the lease. To minimize the risk that the store is shuttered, choose a location with strong sales and low rent to revenue ratio.

3. Financing should be an important consideration. While the cap rate is lower for Walgreens than Rite Aid, you will be able to get the best rates and terms for Walgreens.

4. If you are not a conservative investor or risk taker, you may want to consider a CVS pharmacy. It has BBB+ S&P credit rating. Its cap rate is higher than Walgreens but lower than Rite Aid. Some leases may offer better rent bumps. On the other hand, some CVS leases, especially for properties in hurricane areas, e.g. Florida are not truly NNN leases where landlords are responsible for the roof and structure. So make sure you adjust the cap rate down accordingly. Some of the CVS locations have onsite Minuteclinic staffed by registered nurses. Since this clinic idea was introduced recently, it’s not clear having a clinic inside CVS is a plus or minus to the bottom line of the store.

5. All 3 drugstore chains have similar requirements. They all want highly visible, standalone, rectangular property around 10,000 – 14,500 SF on a 1.5 – 2 acre lot, preferably at a corner with about 75 – 80 parking spaces in a growing and high traffic location. They all require the property to have a drive-through. Hence, you should avoid purchasing an inline property, i.e. not standalone and property with no drive-through windows. There is a chance that these drugstores may not want to renew the lease unless the property is located in a densely-populated area with no vacant land nearby. In addition, if you acquire a property that does not meet the new requirements, for example a drive-through, you may have a problem getting financing as lenders are aware of these requirements.

6. If the pharmacy is opened 24 hours a day, it is in a better location. Drugstore chains do not open the store 24 hours day unless the location draws customers.

7. Many properties may have a percentage lease, i.e. the landlord can get additional rent when the store’s annual revenue exceeds a certain figure, e.g. $5M. However, the revenue used to compute percentage rent often excludes a page-long list of items, e.g. wine and sodas, tobacco products, items sold after 10 PM, drugs paid by governmental programs. The excluded sales revenue could account for as much as 70% of store’s gross revenue. As a result, this author has seen only 2 stores in which the landlord is able to collect additional percentage rent. The store with a percentage rent is required to report its annual sales to the landlord. As an investors, you want to invest in a store with strong gross sales, e.g. over $500 per square foot a year. In addition, you also want to check the rent to revenue ratio. If the figure is in the 2-4% range, the store is likely to be very profitable so the chance the store is shut down is low.

8. It does not matter how good the tenants are, avoid investing in declining, e.g. Detroit and/or low-income areas or small towns with less than 30,000 residents within 5 miles ring. In a small town, it may be the only drug store in town and captures most of the market share. However, if a competitor opens a new location in the area, revenue may be severely affected. In addition, the tenant can always moves to a new location down the road when the lease expires since there is low barrier to entry in a small town. These properties are easy to buy now and hard to sell later. When the credit market is tight, you may have problems finding a lender to finance these properties.

9. Many properties have an existing loan that the buyer must assume. If you have a 1031 exchange, think twice about buying this property. You should clearly understand loan assumption requirements of the lenders before moving forward. Should you fail to assume the existing loan (assuming an existing loan is a lot more difficult than getting a new loan), you may run out of time for a 1031 exchange and may be liable to pay capital gain.

10. With few exceptions, drugstore chains do not own the stores they occupy for several reasons. Here are just a couple of them:

– They know the pharmacy business but don’t know real estate. Stock investors also don’t want Walgreens to become a real estate investment company.

– Owning the real estate will require them to carry lots of long term debts which is not a brilliant idea for a publicly-traded company.

11. About 10% of the drugstore properties for sale and typically CVS pharmacies require very small amount of equity to acquire, e.g. 10% of the purchase price. However, you are required to assume an existing fully-amortized loan with zero cash flow. That is, all of the rent paid by the tenant must be used to pay down the loan. The cap rate may be in the 7-9% range, and the interest rate on the loan could be attractive in the 5.5% to 6% range. Hence, the investor pays off the loan in 10 to 20 years. However, you have no positive cash flow. This requires you to come up with outside cash to pay income tax on the rental profits (the difference between the rent and mortgage interest). The longer you own the property, the more outside cash you will need to pay income taxes as the mortgage interest will get less and less toward the end. So who would buy this kind of property?

– The investors who have substantial losses from other investment properties. By acquiring this zero cash flow property, they may offset the income from the drugstore tenant against the losses from other investment properties. For example, a property has $105,000 of rental profits a year, and the investor also has losses of $100,000 from other properties. As a result, the combined taxable profits are only $5,000.

– The uninformed investors who fail to consider that they have to raise additional cash to pay income taxes.

Out of the Box Thinking

If you put too much weight on the S&P rating of the tenants, you may end up either taking a lot of risks or passing up good opportunities.

  1. A Good location should be the key in your decision on which drug store to invest in. It’s often said a lousy business should do well at a great location while the best tenant will fail at a lousy location. A Walgreens store that is closed down later on (yes, Walgreens closed 119 stores in 2007) is still a bad investment even though Walgreens continues paying rent on time. So you don’t want to blindly invest in a drug store simply because it has a Walgreens sign on the building.
  2. No company is crazy enough to close a profitable location. It does not take rocket science to understand that a financially-weak company like Rite Aid will make every effort to keep a profitable location open. On the other hand, a financially-strong Walgreens will need justifications to keep an unprofitable location open. So how do you determine if a drug store location is profitable or not if the tenant is not required to disclose its profit & loss statement? The answer is you cannot. However, you can make an educated guess based on the store’s annual gross revenue which is often reported to the landlord as required by the percentage clause in the lease. With the gross revenue, you can determine the rent to income ratio. The lower the ratio, the more likely the store is profitable. For example, if the annual base rent is $250,000 while the store’s gross revenue is $5M then the rent to income ratio is 5%. As a rule of thumb, it’s hard to make a profit if this ratio is more than 8%. So if you see a Rite Aid with 3% rent to income ratio then you know it’s likely a very profitable location. In the event Rite Aid declares bankruptcy, it will keep this location open and continue paying rent. If you see a Rite Aid drug store with 3% rent to income ratio offering 10% cap, chances are it’s a low risk investment with good returns and the tenant will most likely to renew the lease. The weakness of corporate guaranty from Rite Aid is probably not as critical and the risk of having Rite Aid as a tenant is not really that significant.
  3. Drug stores with new 25 years leases tend to sell at lower cap, e.g. 6-7% cap on new stores versus 8.0-8.5% cap on established locations with 5-10 years remaining on the lease. This is because investors are afraid that the tenants may not renew the leases. Unfortunately, lenders also have the same fear! As a result, many lenders will not finance drug stores with 2-3 years left on the leases. The fact that drugstores with new leases have a premium on the price means they have potential of 20% depreciation (buying new at 6% cap and selling at 7.5% cap when the leases have 8 year left). Some investors will not consider investing in drug stores with 5-10 years left on the lease. They might simply ignore the fact that the established stores may be at irreplaceable locations with very strong sales. Tenants simply have no other choices other than renewing the lease.

Nutrition Supplements – Why Do People Take Them?

There are many reasons why people take nutrition supplements . Before I discuss the reasons, I will define nutrition and supplements. Nutrition is a science that examines the relationship between diet and health. The science of nutrition discovered hundreds of years ago that deficiencies in diet, excesses and imbalances in a diet can produce negative impacts on a person's health, and these negative impacts may lead to a number of diseases.

A supplement, in the dietary context, means something taken by people to enhance a diet. Supplements can include vitamins, minerals, protein, fiber, and other additives. Those who wish to gain muscle mass take bodybuilding supplements.

An example of one supplement is folic acid. All women of childbearing age and especially those who are already pregnant are being recommended by their medical practitioners to take folic acid to prevent birth defects known as neural tube defects. Scientists have established that there are health benefits for adults also, in doses that are not usually achieved by consuming a typical diet.

Research shows that consumption of vitamin and mineral supplements is common in the United States. People report a variety of reasons for taking nutrition supplements, including reducing their susceptibility to health concerns such as heart attacks, colds, stress, flu and people also take supplements to increase their energy levels. Other reasons for taking supplements are to alleviate the pain from arthritis, to help reduce the symptoms of irritable bowel syndrome, to reduce cholesterol problems, fibromyalgia, chronic fatigue, immune disfunction, osteoporosis, obesity, and alzheimers. People also take supplements to reduce their chances of getting cancer, and to help destroy existing cancer cells. So, science has established that nutrition plays a very important part in our health and well-being. The big question is – can the food we eat supply us with enough nutrients to help ward off disease and illness? There appear to be three different schools of thought in regard to this question.

  1. One school of thought is that if we eat lots of different fruit and vegetables, we should get enough nutrients to keep us healthy. In the Dietary Guidelines for Americans, it is recommended that we should eat five to thirteen servings of fruit and vegetables a day. I do not know anyone who eats that many servings every day, and I do not think there would be many people who do. A lot of people buy their dinner from take away food shops on their way home from work, and while there are more healthier take away food shops opening up, they still do not have very many fruit and vegetables. In addition, the fruit and vegetables we eat need to be fresh, and to be grown from nutrient rich soil. Because of pollution and toxic chemicals in our environment, the food we eat is not pure these days. During the last several decades, the nutritional benefits we could get from food have diminished. Years ago, farmers used to rotate crops to improve the quality of the produce, but that does not happen now. Even organically grown foods are subject to the same contamination as other foods, unless they are grown in a protected environment.
  2. Another school of thought is that specific supplements can be taken after diagnosis of a deficiency in our diet. For example, individuals with signs of a zinc deficiency or iron deficiency, may be recommended to take zinc or iron supplements.
  3. The third school of thought is that prevention is better than cure, and it's best to take a full spectrum of vitamins and minerals. In addition to vitamins and minerals, fruits such as açaí, noni, mangosteen, goji and amla, are considered to be nutritionally superior with more health benefits than those obtained from other fruits. Research has shown that some of these fruits can help protect the body against inflammation, harmful bacteria, oxidative stress, mental disorders, heart damage and high cholesterol. Previously, these fruits were only available in certain countries, but now many of them are being used in supplements so that everyone can benefit from them.

There is another consideration to be taken into account when deciding which school of thought fits into your way of life. Many of the multivitamins in tablet form can not be absorbed into the cells of the body, so they are excreted with other waste materials, and the body gets little benefit from them. Some studies have indicated that our bodies absorb less than 10% of what is on the label on the tablets and capsules.

What is on the label is not important, when it comes to nutrition. What is important, is our bodies ability to absorb the nutrients we take, into the bloodstream, because this delivers real nutritional value.

Liquid nutrition supplements are absorbed into the blood stream right away. They are also a good choice for people who suffer from what we call "pill fatigue" because they are tired of choking down tablets and capsules. Taking tablets can be inconvenient and cumbersome.

To summarize, people take nutrition supplements because they want to keep healthy or improve their health and energy levels. It's not easy to eat enough nutrient rich fruit and vegetables in one day, to provide all our daily required nutrients. Therefore, supplements are a simple and convenient way to help prevent many serious and also the not so serious health concerns. Liquid supplements are absorbed into the bloodstream easily, and are a solution to "pill fatigue".

Using Cut Out Standees Instead Of Pop Up Banner Stands for Advertising

When many businesses consider the production of a free-standing display then the first product that is offered by the supplier is a banner stand. Banner stands are the traditional way of creating a portable marketing display thanks to the relatively low cost and ease of portability.

Unfortunately, it is the success and great popularity of the banner stand which sometimes means that they are overlooked in favour of more innovative types of display stand which are capable of grabbing the customers attention more so than a relatively common roller banner which houses a basic rectangular print.

When formulating strategy regarding your next promotion, it is worth discussing options with potential suppliers with a view to finding non-standard solutions that could well yield more ‘bang for buck’ than off the shelf products.

Children In Need are one of the highest profile charities in the UK, raising many Millions of Pounds each year for worthwhile causes through nationwide events and a television appeal. In 2010, a series of free-standing cut-out standees were manufactured and used on display at BBC Television Centre prior to the event and at various locations during the filming of the event.

The utlisation of shaped cut-outs when compared to standard banner stand display is quite noticeable and the standees were uses to great effect to raise awareness and assist fundraising for the charity.

For those interested in cut-out standees in place of roller banners, the costs are broadly similar with a 6′ tall x 3′ wide standee being available for around the same cost. In terms of the material the standee if printed onto, there is a variety of choice that can be tailored to the environment in which the display stand is to be positioned. For example, the Pudsey standees seen in this example were manufactured using a fire rated, foam centred board which made then extremely lightweight in order to comply with stringent safety requirements at the venue concerned. Other standees were produced using a more rigid PVC Foamex board which is capable of undergoing transport to and from events without being so susceptible to damage caused by occasional knocks and bumps.

If you are considering using a standee for your event, exhibition, trade show or retail display then it is worth selecting an image which will provide a smooth, slowing cutting path. It is worthwhile avoiding cutting-around very small objects such as fingers which can be broken-off when the standee is transported.

How Green Tea Can Help With HPV

There are many different strains of the Human Papillomavirus. To date, there are over one hundred to be exact! It has been estimated that up to thirty of these strains can lead to the onset of cervical cancer. Then, of course, there are types that can lead to the development of irritations on the skin, warts on the skin, and even genital warts. This is a relatively common strain of viruses, as it turns out. Approximately thirty million individuals in the United States alone have a strain of this type of virus. Conclusive evidence indicates that once an individual has this type of virus for approximately two to three years, the immune system clears it up automatically. Here, I will review how green tea can help with HPV.

The Health Benefits of Green Tea

There are many health benefits of green tea. This type of beverage is believed to be loaded with a large number of antioxidants. This beverage is an effective means of preventing several different health complications. The following details some of the conditions and diseases that green tea has proven to be successful in preventing:

1. Men who drink this beverage on a regular basis have been found to have less of a chance of developing prostate cancer.

2. For individuals who suffer from high blood counts, green tea can effectively reduce the count to a healthy number.

3. Those that are risk for serious conditions like heart attack and stroke, this substance may play an important role in the prevention of these serious conditions.

4. Drinking this tea on a regular basis may assist in the prevention of arteriosclerosis.

5. Cerebral thrombus has been successfully prevented with this beverage.

6. Those that stand a chance of developing dementia and Alzheimer’s disease reduce their chances drastically by ingesting this substance.

7. Green tea is very effective when it comes to burning fat and increasing the overall metabolism in the body.

8. The immune system may receive an optimization by ingesting the ingredients that are part of the tea.

9. This has been found to reduce the amount of infections that the body experiences. HPV is just one of these infections.

10. The overall maintenance of the body is drastically increased when an individual ingests this type of tea.

The Dangers of the HPV Vaccine

We see the commercials and we hear the advertisements…all people – especially women – should get the HPV Vaccine. Mostly women because cervical cancer is a common side effect of HPV. Unfortunately, most of us do not hear about the dangers associated with the HPV vaccine. The following represent some of the complications that have been associated with this vaccine:

1. Not all strains of HPV are covered by the vaccine, so in many cases it is completely ineffective.

2. The vaccine may actually weaken the immune system.

3. Nearly 10,000 complaints have been filed against the vaccine, called “Gardasil”. These complaints are due to the adverse side effects that occurred once the vaccine was administered.

4. At the date in which this is being written, it has been estimated that approximately twenty people have died as a result of the Gardasil vaccine for HPV.

5. The manufacturer of this particular vaccine is completed protected from lawsuits that have to do with untimely deaths as a direct result of having the vaccine performed.

6. Many untimely deaths are a direct result of symptoms such as blood clots, cardiac rest, and even respiratory failure. There are a number of deaths that are contributed to causes that are considered to be unknown.

Cervical Cancer Prevention

There are a number of ways that cervical cancer can be prevented, apart from indulging in the HPV vaccine. The following lists some strategies:

1. The HPV infection is sexually transmitted, so it is important to properly protect yourself during intercourse.

2. Learn the early symptoms of both HPV and cervical cancer.

3. Consume a large amount of green tea.

4. Take the steps necessary to increase the effectiveness of the immune system.

5. Engage in a healthy diet and exercise program.

Conclusion

If you are battling HPV, it is much more effective to avoid the HPV vaccine and do things that are healthy to combat this condition. Drinking green tea and building the immune system with healthy foods and an exercise program are the best steps to take.