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REAL ESTATE ADVISOR Tips & Tools from the world of todays Realtor

The Right Way To Get Out Of A Real Estate Investment By James M. Dahle, MD, FACEP, Editor, The White Coat Investor,

http://whitecoatinvestor.com Reprinted with permission

It is relatively straightforward to get out of an investment in stocks, bonds,

or mutual funds. You go onto your computer, make a few clicks, and voila,

youre out. Depending on the type of account, there may be some tax

consequences. In a tax-free account like a Roth, an HSA, or a 529, there

pretty much arent any. Likewise in a tax-deferred account like a 401K or

traditional IRA, although there may be some planning as far as when and

how to take the money out of the tax-deferred account eventually. You

have to be a little smarter in a taxable account, where you can either hold an investment for at least a year to pay the

lower capital gains rates, donate it to charity to avoid taxes at all, or just die and pass it along to your heirs tax-free.

Investments in individual properties are a little more complicated.

The Home You Live In

Getting out of the home you live in is more straightforward than an investment property. You can usually sell the place

and move on to the next one. There are a few selling costs, including realtor commissions, repairs, and vacancies (the

time youre paying the mortgage but not actually living there) which are not insignificant. Ive found that 10% of the

value of a property is a pretty good estimate of the selling costs, but it can be done for less if youre willing to sell it

yourself or if you can avoid having it sit empty. There can be tax consequences as well. Since the repeal of Section 1034

in 1997, Section 121basically allows you to exclude from income up to $250K ($500K married) in capital gains from the

sale of your primary residence. This essentially eliminates the tax consequences of selling a home for most home sales.

Obviously, this provision of the tax code is highly discriminatory against those who live in expensive real estate markets

like the Bay Area and Manhattan, as well as against those who stay in their homes for a long time.

The 1031 Exchange

Investment property is not entitled to this exclusion unfortunately. Section 1031, however, does allow you to exchange

your investment property equity into another property while deferring the capital gains (and depreciation recapture)

taxes due. This works fine until you wish to get out of real estate investing all together. Then what are your options?

The Tax Bill

Option number one is to just pay the capital gains and depreciation recapture taxes due. If you bought the property for

$100K, then depreciated it down over 14 years to $50K, and sold it for $200K, then you owe capital gains taxes on

$150K. That could be as much as 23.8% of that $150K, or $35,700. Thats enough to make any investor stop and

wonder if theres a way to avoid that.

Death or Taxes

Option number two is to die. If you buy a property worth $100K and 50 years later youre on your deathbed and the

property is worth $1M, youve got two choices. You can sell it today and pay 23.8% of $1M (since its now fully

depreciated), or you can leave it to your heirs, who sell it the day after you die and owe no capital gains taxes, although

your estate may possibly owe taxes if it is over $5M ($10M married). The property gets a step-up in basis at your death,

so basically its as if they bought it at its value on the day of your death. Voila- an extra $238K for them.

Live In It

Whats that you say? You dont want to die or pay taxes. Luckily for you, there are a few more options. The best of the

rest might very well be to live in the property. Once it becomes your principal residence, you are again eligible for that

tax exclusion of up to $500K (married) of depreciation recapture and capital gains taxes. You have to own the property

for at least 5 years and live in it for at least 2 years to qualify under Section 121. Preferably, you live in it for at least 5

years to get the maximum exclusion. If you had only lived in it for 2 of the last 5 years, even though you owned it for 5,

you only get 2/5 of the maximum exclusion.

The obvious issue here is that most investment property owners dont actually want to live in the type of property they

invest in. Who wants to move from a 3000 square foot house into a 2 bedroom apartment for 5 years just to save $30K

in taxes? There is another option. You can do a 1031 exchange from an investment property you dont want to live in

into an investment property you would want to live in. You then rent it out for a while before moving your family in.

How long do you have to rent it out for? The IRS doesnt specify. The only requirement is that you have the intent to

rent it, and can prove it in an audit. Id think a year of renting it out would be plenty, but it would probably be wise to

consult with an attorney and/or accountant familiar with case law if you want to minimize this period.

Work In It (Do You Really Want Out of Real Estate Investing?)

Another option is to exchange the investment property into a building youre now leasing for work. You get away from

the hassles of managing tenants and save on rent, but dont owe any capital gains taxes on the exchange. Depending on

why you want out of real estate investing, you might also be happy simply exchanging into a property requiring less

management time, effort, and expense.

Give It Away

Another way to avoid those capital gain and depreciation recapture taxes is to give the property away to charity. The

charity can then sell it tax-free and you get a deduction for the entire value of the property. Lets say it is a fully-

depreciated, paid-for property worth $200K. You get a write-off for $200K (possibly saving you up to $100K in taxes

depending on your marginal tax rate), the charity gets $200K (minus transaction costs) and the IRS doesnt get squat.

While you dont have to pay taxes, you do lose the property. Paying $200K to save $50K isnt exactly a smart business

move. If youre not feeling quite that charitable, you could do a charitable remainder trust. That means you give the

property to the charity and they establish a trust for you for a certain number of years, such as 15-20, or until the death

of you, you and your spouse, or all your grandchildren if you like. They sell the property and fund the trust with

relatively conservative investments and use them to pay you interest for 15 years. Then whatever is left belongs to the

charity. Its like buying an annuity (although the interest rate is significantly less, but by law at least 5%). You also dont

get to deduct the full value of the donation, only the present value of the ultimate donation (the remainder), which must

be at least 10% of the value at the time of the donation. Why would the charity do this? All charities wont, but those

who do figure 10%+ in 15 or 20 years is better than nothing now. Many will put limitations on the trust as well, mostly

because it isnt worth the hassle if they have to wait too long to get your money.

The Worst Way

Given the other options, just selling and paying the tax may not be the worst way to get out of the investment

(especially if you have a loss on it.) But if you do this over and over again, it reflects a lack of planning on your part. If

youre going to be a real estate investor, do it for the long-term, exchanging from one property to another as needed,

and then you only have to deal with the costs and hassles of getting completely out of real estate once.

Be sure to check out Dr. Dahles new book currently selling on Amazon: http://www.amazon.com/The-White-Coat-

Investor-Investing/dp/0991433106/

Hoisted on our own petard

As though we needed another reminder that we face a growing problem

with drug resistant strains of bacteria, the CDC announced that a stomach

bacterium is becoming resistant to antibiotics. Shigella sonnei is now

resistant to ciprofloxacin which has been the pharmaceutical of choice to

shorten Shigellosis. Similar to saimonella or e.Coli, Shigellosis causes fever,

abdominal pain, and diarrhea which can last from several days to a full

week. Fortunately the infection is seldom fatal and most people recover

fully.

But it casts another spot light on a problem that, if trend lines extend

uninterrupted, could lead the human race back into an age where common

infections and minor injuries can become fatal. Most of us from the baby boom generation have never experienced the

ravages of bacterial infections that were common in the pre-antibiotic era. We take for granted that if we get a scratch

or a more significant wound, or if we have to have a surgical procedure, any resulting infection is nothing more than an

inconvenience that can quickly be controlled and eliminated with a week of white tablets.

But that very dependence has led to the birth of super bugs, immune to many, and in some cases, all anti-biotics in the

doctors bag of meds. Heres the problemwe get a cold with annoying symptoms, we go to the clinic and demand anti-

biotics. We get a prescription from an accommodating physician and within days the symptoms abate and eventually

disappear. Problem is, most colds are viral not bacterial. And physicians know this. Yet they are not willing to argue

with a patient. So they prescribe an anti-biotic with the rationale that it wont do any good but it wont do any harm.

And as long as the doctor prescribed the pills, the insurance companies pay the bill. Everyone is participating in a

charade that may one day have devastating consequences. The problem is that bacteria may not be as smart as humans

but they do have a built in instinct for survival. And there are billionstrillions more bugs than people. We keep over

using anti-biotics and gradually some bugs survive. And they develop immunity. And they pass this immunity on to

millions and billions of other bugs. And in some cases there is evidence that the immunity can be shared and

transmitted to other strains.

So, you say, lets just develop a new anti-biotic that will kill the new super bug. We arent going to let an organism that

is only one cell large outsmart the collective intelligence those of us at the top of the food chain. But sadly our arsenal

of anti-biotics is made up of truly miracle drugs. And miracles cant be duplicated as easily as one might imagine. In fact

there are virtually no new anti-biotics in the pipeline. Simply put, the bugs are winning, they out number us and they

have all the time in the world to persevere. Worse yet, we are arming the enemy with our foolish over use and misuse

of the anti-biotics that we have.

Add to the problem the growing use of antibiotics for livestock and crops and we may well be on our way to a return to

the middle ages of medicine. The World Health Organization recognizes that antimicrobial resistance is a global

problem. In the US the Obama administration has recognized the threat and announced a five-year plan to combat

antibiotic resistance. But this is not a problem that can be combated in isolation. Unless every man woman and child,

every doctor, every healthcare professional starts pulling on the same end of the rope, all of mankind, rich and poor may

find themselves hanging from a medical noose of our own crafting.

Spit in a vile genetic testing

We have all seen the TV ads. A young woman approaches a door and suddenly

is transported back in time, a line of suffragettes fade in and fade out; a young

woman climbs out of a window to join a young man; and the next thing you

know a baby is left at the door step of a monasteryinteresting social

commentary there. The advertisement encourages the viewers to visit

Ancestry.com and research their family tree.

What a lovely little boutique company you might say. I mean, just how many

folks are going to pay to find out if any of their great-great-great grandparents passed through Ellis Island? How about

$1.6 billion worth of folks. OK, fine, Ancestry.com is a big company making a lot of money. What does all this have to do

with spitting in a vile you ask? Well this hobby lobby for family trees is about to become one of the most powerful

medical research tools in the world.

I was doing some unrelated research online the other day and stumbled across www.Ancestry.com/DNA. I discovered

that Ancestry.com has been quietly collecting and analyzing huge amounts of genetic data for just over three years. And

through the wonders of DNA science, you can find ancestors you never knew you had, discover your ethnic mix, and

uncover new details about your unique family history all for the incredibly low price of just $99. Simply spit in a vile and

send it in. Ancestry will search their growing network of DNA members and identify any people that share your DNA.

They will search their family trees and fill in blank spots on yours.

A very benign use of DNA testing that isnt subject to any level of government regulationsimple, innocent and mildly

entertaining. Not so fast. With over 800,000 DNA samples from all corners of the globe, Ancestry is poised to pass up

Googles genetics company, 23andMe. Keep in mind that although Ancestry has been using the DNA data to put little

green leaves on family trees thus far, that DNA contains an entire forest of health data. The fact that Ancestry has been

around in one form or another for decades (the companys own family tree traces back to the Mormon Church) and has

been collecting data about generations of family members it is not a huge step to providing family health history and

hereditary conditions that can predict potential future health issues.

But making the step from a family tree pruner to a medical research company is going to mean entering the government

regulation arena. And they would be well served to do some research of their own into the nightmares that 23andMe

has experienced with the FDA. In fact their own spit-in-a-vile test kit was recently blown out of the water by a cease and

desist letter that took them out of the consumer genetic testing arena.

But trying to keep the DNA genie in the bottle (or vile as it may be) is going to be impossible. There is simply too much

valuable science to be had from databases of these sizes. And the motivation that a companies like Ancestry and Google

have is the potential to monetize their data. That means that they will probably be more than willing to make the data

available to scientists as long as they can analyze and sell it to the public.

The government is simply not clever enough to block the Silicon Valley geeks and their venture capital buddies for any

period of time. Sooner or later, probably sooner, John Q. Public will be able to spit in a vile, send it in and find out

anything they want to know about what his genes have planned for him and his children. And who knows if you are

willing to pay for your genetic forecast, they might even throw in a family tree for nothing; simply pay for shipping and

handling.

A Tree Grows in Berkley

With the caveat that I will probably not see this new technology come

to pass in my life time, there are some fascinating things going on in

the labs at Berkley. If one accepts the premise that global warming is

being caused in part by manmade gasses such as CO2, any technology

that promises to cut down on production while at the same time

scrubbing the atmosphere of CO2 has to be good news.

It has been reported that some of the brain cells at UC Berkley have

come up with what amounts to an artificial leaf. Now it isnt

something that will be gaffed to a tree but it will work in much the

same way that a living plant does, using sunlight to synthesize CO2 into useful chemicals such as oxygen. Only in this

case they are using a semiconductor-bacteria hybrid of sorts.

Their devise has already been tested and has reached a second generation application. At the heart of the invention is a

setup that is have biological and have machine. The end result is artificial photosynthesis. But there is an added benefit

to this mad science shade tree. The chemicals that the process creates as a byproduct might one day create renewable

fuels and other petrochemical feed stocks.

It is presently a two step process there is the actual photosynthesis and then there is a second step that synthesizes the

initial by products into more useful chemicals that hopefully will one day include liquid fuels and even new

pharmaceuticals. Im no biologist so the Sporomusa ovate bacteria used in the first part of the process and the E.coli

used to further the conversion into useable chemicals dont mean a lot. But Im sure that some bioengineering will go

into making these basic bugs even better at doing what they do naturally. And that type of further development is what

will take time.

But the scientists doing the work are pretty stoked about what they have achieved. Peidong Yang one of the lead

chemists on the research team believes that their system is a revolutionary leap forward in the field of artificial

photosynthesis. The gas and oil industry giants may want to keep an eye on the research because a possible end goal

of the research are vast fields of artificial leaves scrubbing the atmosphere of bad gas and turning it into renewable

supplies of fuel with nothing more that the power of the sun and some well trained bugs.

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Dikes expertise in personal change was developed through a combination of 11 years as a

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entrepreneurs; he has also developed his own unique, interactive guided imagery practice.

Choosing Wiselyan initiative of the ABIM Foundation

Here is a website that primary care physicians in particular should

visit. With the steadily rising pressure from Obamacare to control

healthcare costs, with the recent Doc Fix promising a more stable

but a drastically reduced annual increase in Medicare

reimbursement and with the healthcare industrys commitment to

outcome based business models, www.chosingwisely.org is a

website committed to promoting conversations between providers

and patients which help patients choose care that is:

Supported by evidence

Not duplicative of other tests or procedures already received

Free from harm

Truly necessary

I first became aware of this site after a visit to my VA primary care physician. We were discussing treatment options

available to treat and control my Chrones Disease. She suggested that I visit the site to see what information might be

available to help me better understand treatment and testing options. The site offers links to lists of Things Physicians

and Providers Should Question in recognition of the importance of conversations to improve care and eliminate

unnecessary tests and procedures. The lists were developed by United States health care provider organizations

representing more than one million providers.

Quoting further from the site, These lists represent specific, evidence-based recommendations providers and patients

should discuss together in order to make wise decisions about the most appropriate care based on their individual

situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology

used in its creation.

Partner organizations are collaborating with Consumer Reports to create resources for consumers and providers to

engage in these important conversations about the overuse of medical tests and procedures that provide little benefit

and in some cases harm. The encouraging thing about this initiative is that it is driven and supported by the healthcare

industry and not the government. Even the VAs support of the online resources provided by the project takes place at

the physician level.

For years politicians and pundits have pointed to wasteful duplication in the use of tests and the distribution of

healthcare and the use of defensive medicine by providers designed as much to defend against possible litigation as to

provide quality care. Granted, the absence of industry wide electronic medical records and efficient, secure means of

transmitting and sharing healthcare data has been partly to blame. But an uninformed consumer with little or no access

to accurate objective information to guide their healthcare decisions has impeded previous government and industry

attempts to control costs.

Choosing Wisely posts the disclaimer that recommendations on the site should not be used to establish coverage

decisions or exclusions. But they go on to suggest that they are meant to spur conversation about what is appropriate

and necessary treatment. The fact that an industry sponsored and supported resource is now available and that

primary care physicians are committed to considering informed input from their patients is an encouraging development

that warrants active coverage from the mainstream press.

Arizona law anticipates Supreme Court ruling on Obamacare

Governor Doug Ducey of Arizona signed legislation that prohibits Arizona from

establishing a state-based health exchange under Obamacare. Now that would

seem to make little sense in that Arizona has already opted out of any state

exchange. Arizona residents who do not have employer provided health insurance

must purchase from the federal marketplace at healthcare.gov in order to receive

premium subsidies. And of the more than 154,000 state residents who have

signed up, 76% do in fact receive tax credits that reduce their monthly premium

costs.

So why pass legislation that prohibiting something that doesnt exist? Governor

Ducey is betting that come June, the US Supreme court will rule that subsidies for

residents of states using the federal exchange are unconstitutional. It would appear that the congressional aides who

wrote the Affordable Care Act made a bit of a typo that allowed for subsidies from state run exchanges but failed to

mention subsidies from the federal exchangesome typo! Obamacare proponents say that the spirit of the law is clear

and the Supreme Court should overlook the fuzzy language. Opponents say that the law is the law and it should be

enforced as it is written.

If the Supreme Court rules as he hopes the governor believes his legislation will help drive a stake through the heart of

the ACA . He believes, as do many GOP governors, that government mandates for broader health benefits are driving up

the costs of premiums for everyone. If Obamacare can be destroyed, Ducey believes that a new era of less expensive

health insurance plans. The fact that the immediate impact of the legislation would be to deprive more than 154,000

Arizona citizens of affordable health insurance is collateral damage.

Without subsidies it is estimated that premiums would increase by over 120% for those receiving subsidies. But it

should be noted that Arizona has actually increased Medicaid coverage for the poor using funding from Obamacare and

matching funds from hospitals. So the poorest of the poor are not actually impacted one way or the other. Those most

affected are the working poor who dont qualify for Medicaid. Throwing so many of the states citizens under the bus is

a curious strategy indeed.

But the governor believes that desperate times require desperate actions. And if barring any possible future state

exchange wasnt enough, the legislation also prohibits any use of state funds to enforce the federal healthcare law. So,

the battle lines have been drawn in Arizona and now we must await the ruling from the Supreme Courte. If they rule in

favor of the federal subsidies, the governor and his allies across the country and across the GOP will simply have to find

another means to defeat the Affordable Care Act.

Of course, the diehard critics of Obamacare hope that a Republican president and control of both the House and the

Senate could provide a final solution for the ultimate repeal of Obama care. But Republicans may want to be careful

of what they wish for. They may not like elements of the socialist state such as Medicare and Social Security but they

arent crazy enough to try to repeal them. They may be underestimating the popularity of subsidized health insurance

paid for by the wealthy in support of the disserving poor.

A Very Slippery Slope Indeed

For years now, scientists have been grappling with the ethical

problems presented by the potential to engineer human genetic

material. There has been a good deal of hand ringing but not

much substance to the call for clear guidelines in this

contentious arena. And now comes the revelation that a team

of Chinese researchers have succeeded in genetically

engineering a human embryo.

The report that appeared last week in the journal Nature News,

has turned up the volume of the debate. The study was led by

Junjiu Huang at Sun Yat-sen Universitys gene function center

and his team of researchers. They obtained their embryos from

a fertility clinic and were careful to point out that they were

nonviable and could not in any way result in a live birth. World scientists were hardly reassured.

The Chinese research was targeted and very limited. They were attempting to modify one gene that was responsible for

a rare inherited blood disorder. Although one can hardly discredit their motives, the very idea of tampering with human

embryos at this stage of our scientific knowledge is troubling.

Consider thismost reputable scientists who will even discuss the idea of gene splicing in a viable human embryo for any

reason can only be considered when the chances of success approach 100%. In the research described by the Chinese

team the numbers are anything but comforting.

86 Embryos were injected with replacement DNA

71 Embryos survived the procedure

54 four of the surviving embryos were tested

28 were spliced successfully

The actual number of those spliced successfully that possessed the substituted genetic material was not

divulged but was described as a tiny fraction of those processed.

Dr. Huang stated that the study has been stopped because the technique adopted by the team is still not mature

enough for being tested on human embryos. But one chilling element of the study is not contained in the numbers

above. Scientists were surprised by the high number of unintentional mutations that took place during the procedure.

Although it might be an overreaction to decry the research as an attempt to create a super race or designer children, it is concerning that this type of research is ongoing at a time when technology has simply not reached a stage where anything approaching success can be expected. Images of secret, government controlled medical facilities turning out deformed, mutated human clones were once the stuff of late night science fiction fare. Now Im not so sure.

Sometimes the obvious is not the actual

Take the case of Jean Sharon Abbott. When she was 4 years old she was

diagnosed with a form of cerebral palsy. She had all of the classic

symptoms of cerebral palsy. Her doctor was one of the leading pediatric

specialists in this group of diseases. There was absolutely no question that

the diagnosis was the right one. Second opinions confirmed the primary

diagnosis. So Sharon learned to live with the disease. Hers was not

necessarily a story of unimaginable pain and suffering. She went to

school. She had close friends. She was a bright student. She had loving

parents. She just wasnt like everyone else.

At age 12 she had the muscles from her hips detached and reattached so

that her knees wouldnt hit each other when she walked. Not an

uncommon procedure for cerebral palsy patients. It provided some

improvement. But the price was a body cast for a month.

At age 28 Jean had a medicine pump implanted in her bodyagain, not an uncommon procedure. But this time things

did not go well. She was referred to a physician who specialized in these pumps and the new physician made a startling

observation. And it had absolutely nothing to do with the pump. She expressed serious doubts that jean was actually

suffering from cerebral palsy! After examining her new patients and asking some probing questions she announced that

Jean might well be suffering from DRD, dopa-responsive dystonia.

DRD is a disorder that is often misdiagnosed as a form of cerebral palsy. It features the same involuntary muscle

contractions. But the good news, the absolutely unbelievably good news, was that the condition is treatable with a

medication called L-Dopa. Consider how you might react after spending the first three decades of your life suffering

from a debilitating condition that robbed you of your mobility and your dignity, then being told that a readily available

medication could reduce or eliminate her symptoms.

To her credit Jean was overjoyed and not bitter. At first she thought the news was in fact too good to be true. But after

a mere week on the new meds her symptoms began to abate. Fast forward five years. Her husband and she decided to

relive their honeymoon, a 1,000+ mile drive around one of the Great Lakes. Only two months after receiving a new

lease on life and with the effects of her meds fully in place, they capped their trip with a 10 mile hike!

Sometimes the obvious is not the actuala cautionary tale for all doctors to consider.

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care professionals thrive in the era of ObamaCare.

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offers a bridge between the world of medicine and the world of business.

A Cure for Asthma? It seems as though we hear news of medical research gains nearly daily. And it is heartening that behind the scenes,

scientists are devoting their lives and their skills to a search for cures. That would seem to be the case for a disease that

affects nearly 300 million people worldwide. Asthma is not a killer like high visibility diseases like Aides or Ebola. It isnt

mutating into drug resistant strains like tuberculosis. In fact it is relatively well controlled in most patients with

treatment protocols currently available. But relieving 300 million souls of regular debilitating attacks of breathless

anxiety is a prize worth winning.

The breakthrough if it is indeed a breakthrough was published by researchers from Kings College in London and Mayo

Clinic in America. Here is the long and the short of it. Researchers found that a specific protein called a calcium-sensing

receptor (CASR) is a root cause of Asthma. And with that discovery they began testing existing medications on tissue

samples from asthmatic and non-asthmatic people (tissue samples not real live people at this stage) and found that

calcilytics, a class of drugs was effective in manipulating CaSR to reverse the symptoms of Asthmanot just partially but

completely! The principal investigator, Professor Daniela Riccardi was excited. If we can prove that calcilytics are safe

when administered directly to the lung in people, then in five years we could be in a position to treat patients and also

potentially stop asthma from happening in the first place.

That sounds to me like a curenot just a treatment. For the 300 million with asthma and in particular for the 15 million

patients who do not respond to current treatments, this is good news indeed. But on a cautionary note Dr. Samantha

Walker, Director of Research and Policy at Asthma UK points out that asthma research is terribly underfunded. Asthma

is simply not an A list killer. But when one considers that CaSR appears to be a prime cause of inflammation in lung

tissue, we could be looking at a potential cure for other diseases of the lung like COPD and chronic bronchitis, for which

there is no cure. This class of diseases is forecast to become the third biggest killer of humans within the next five years.

Some Hope for a Malaria Vaccine For the past 30 years a team of researchers at GlaxoSmithKline working in concert with a non-profit research foundation

established and funded by the Bill & Melinda Gates Foundation have been searching for a vaccine that can defeat a

disease that threatens nearly half of the worlds population. And it would appear that they have achieved some limited

success.

The focus of clinical trials in Africa has targeted young children. With the completion of those trials and the results in

hand it seems that a vaccine is now available that provides partial protection for up to four years. The vaccine was

developed with young African children as the targeted population. It now awaits approval by regulators such as the

World Health Organization. If the approval process moves forward promptly, the vaccine could be available as early as

this fall.

The vaccine named RTS,S displayed limited effectiveness in some early trials on over 10,000 children from seven African

nations. Only about 46% of babies in the trial showed some resistance to the disease and that resistance dissipated over

several years. But more recent studies of the vaccine revealed that protection extended to four years and that booster

shots improved results. When one considers that malaria claims over 650,000 lives every year, any success is

welcomed. And after years of research this is the only vaccine that has provided even partial protection.

The actual data on the trials were published in the Lancet journal last Friday. Even with the limited protection offered by

the new vaccine, if one considers that in 2013 there were nearly 200 million malaria cases, wide spread introduction of

the vaccine could prevent millions of cases of malaria in children across the globe.

Dont Ya Just Love a Family Squabble? Ah, Dr Oz (Dr. Mehmet Oz) your friends and colleagues are becoming a bit distressed by your celebrity and fame. It

would appear that some of his fellow physicians at Columbia University have in fact become so disenchanted with his

fringe medical advice that now is dispensed on his syndicated TV show, The Dr. Oz Show that they are calling for his

dismissal from the Universitys surgery department. My, myphysicians rarely show such public disapproval of a fellow

practitioner.

Dr. Oz is unfazed by the brouhaha. He states that, Without question, the show will survive it. He told Matt Lauer on

the TODAY show that he intends to keep doing the show for as long as he can because he thinks he plays an important

role in making America a better place. In an op-ed that appeared in Fridays USA Today, his colleagues expressed

dismay at his promotion of dubious weight-loss products and a number of other items. Lets be honest here folks,

conservative main stream physicians get their shorts in a knot when one of their colleagues begins using words like

radical and miracle when discussing commercial, over the counter health products.

Dr. Oz stands by his words. Im proud of all those words. Well hes proud of most of those words with the possible

exception of some of the statements he made about weight-loss supplements. I got a particular kick out of comments

from some of his Columbia pals expressing particular discomfort with Ozisms regarding metabolism game changers.

I didnt realize until now that doctors on call on the grave yard shift actually paid attention to miracle supplements

hawked on late night cable TV.

And then the establishment spokes persons got really nasty. Questioning Dr. Ozs motives they blasted his comments

crying that his unsubstantiated medicine sullies the reputation of Columbia University and undermines the trust that is

essential to physician-patient relationships." But they need not worry that the public will misread the comments of Dr.

Oz as medical advice. When asked by Stephanie Gosk of NBC, Dr. Oz clarified that his show is there to discuss the good

life, not medicine. I get it now.

Skin Ink vs. Modern Technology In prior posts your author has admitted that one of his passions is motorcycle touring. As the saying goes, Only a biker

can understand why a dog sticks his head out of a car window. Please understand that the group that I ride with can

hardly be characterized as a biker gang. We are in fact a group of over the hill, semi-retired business professionals riding

ridiculously expensive motorcycles at relatively sedate speeds. And although some of us sport a tattoo or two in mostly

low visibility areas a recent article that I stumbled upon gave me pause.

It would appear that the new Apple Watch does not like skin ink. In fact, the Apple Watch seems to go schizoid when

strapped on over a tattoo. Appearing in the Inquirer, a venerable depository of reliable scientific fact, Carly Page as staff

writer complained that his pricy new 42mm SS watch went caput every time he strapped it too his wrist. The screen

kept locking up and asking him for his password.

It would seem that Apple designers in even their wildest testing scenarios did not tumble to the potential problem the

wrist sensor in their device might have with skin that had been artificially pigmented with tattoo ink. They might be

forgiven for this oversight but it does spot light an element of their technology that is really quite fascinating. According

to the company their sensors use light waves to track the flow of blood through the skin. Obviously the blood is red so

anything that masks or interferes with that color renders the watch mute. No word forthcoming from Apple yet. But

the bikers of the world may be well advised to hold off on an Apple watch purchase until this issue is addressed. Of

course a heavily tattooed biker is probably not Apples primary market anyway.

THE RECRUITERS CORNER Tips and Tools from Todays Physician Recruiter

So, you are finally completing your Residency or Fellowship and you

have secured a job with a first rate medical practice in a city near

where you wanted to be. Or as a skilled practicing physician you

have decided to move for a better opportunity. All of the hard work

is ready to pay off. So why do you need interviewing advice. Well,

believe it or not, the process is not over and some important things

need to be considered.

You have had your employment contract reviewed by a qualified

attorney who specializes in medical contract law (lets hope so). You

have formally accepted the opportunity in writing (not verbally). You have discussed the relocation process and

reimbursement provisions prior to signing the contract (of course you did). And now its time to complete the last hectic

days of your medical training and relocate yourself, your family and your possessions.

From this point until your first day in the clinic, its all about communication. Just because you have secured the job and

signed the contract doesnt mean that you can drop off the grid and stop communicating with your new employer.

There will be all sorts of issues to resolve and these will require your active participation.

You will need to keep the practice updated on your application for a state medical license.

You will need to keep the practice updated on your application for credentialing at the hospitals that you will

serve.

You will need to keep the practice updated on your relocation plans

When will you arrive?

Who is handling the process?

What reimbursable expenses have been incurred?

And a whole host of trivia that you will need to address through and between you and the practice manager.

There will be a whole host of issues that will require your active participation on the home front. If your spouse will be

handling the relocation process while you complete your medical training you will be well advised to stay involved.

If you have school aged children, will you be using public or private schools at the new location?

Will you be listing your current house for sale?

Will you be purchasing a new home at the other end?

Will a professional moving planner be involved?

Are you keeping the kids in the loop? They may be taking the move much harder than you are.

You will need a new insurance agent, a new banking relationship, a new Realtor, a new local attorney.

In short you and your significant other need to sit down and put together a detailed relocation plan and then

you need to divide the labor fairly.

So, accepting the job was only a mile post and not the end of the process. And, completing the journey successfully will

be all about good communication, planning and sharing the load.

NEW HEALTHCARE OPPORTUNITIES

Provided by MedicalMatch.org

Emergency Medicine - Atlanta, GA - EmergiNet

You may know Atlanta as the unofficial capital of the South, but theres more to this city than its southern location. If you make your home in the Peach City, youll find an undeniable mix of Southern charm, sophistication and traditions. Atlanta continues its reputation as a transportation hub with the worlds largest airport and easy access to I-75 & I-85. When it comes to Atlantas reputation for growth and innovation, health care tops the list as the citys facilities expand and improve services across the metro area. Serving some of the fastest growing hospitals is EmergiNet.

EmergiNet has positions available for BC/BP, EM residency trained physicians for work in hospitals

surrounding the Atlanta metropolitan area. We work as a team emphasizing quality emergency care, dedicated

customer service, professional and personal growth. Highlights include: Fee-for-service model having most

MDs starting at around $350k with no ceiling; Profit sharing plan after first year including tax-deferred compensation to supplement 401k(100% vested immediately); Physician-centric practice owned and run by

physicians; All facilities located within 30 minute drive from downtown Atlanta.

EmergiNet provides a full range of clinical and administrative professional services to the facilities we serve.

Our mission is to maximize patient care and facility resources, as well as educate, facilitate and integrate the

delivery of health care within the community. We continually seek ways to enhance the level of excellence and

quality in the services we provide to our clients. To review this and other opportunities E-mail CV to Neil

Trabel, ntrabel@emerginet.com; fax 770-994-4747; or call 770-994-9326, ext. 319. Please

visit www.emerginet.com for more information.

Neurologists with stroke experience Tulsa, OK AIM Consultants

AIM Consultants is currently recruiting 2 Neurologists with stroke experience to join the Neurohospitalist

program at Hillcrest Medical Center, the flagship hospital of the Hillcrest HealthCare System, licensed for 691

beds and located in Tulsa, Oklahoma. We also have a new Neurology position in Oklahoma City!

Staff Physician Needed Toledo, OH The Pediatric Center

Staff Physician needed immediately to join an established Pediatric practice. You will be joining a medical

staff that includes 3 physicians, 6 mid-level providers, supported by 12 nurses. The practice is affiliated with 5

hospitals. Our physicians round on newborns only. We do not attend c-sections. We utilize pediatric

hospitalists and/or specialists for patient admissions. Mid-level providers are on call for parents/patients.

Family Medicine - Central Michigan - L Marsh & Associates

Family Medicine - central Michigan - M.D. or D.O., with or without OB. Join multi-specialty Practice, salaried

or private practice. Primarily outpatient, some inpatient. Call 1:4. One hour to Lansing (Michigan state

capitol). Many lakes for fishing, boating & camping and all outdoor and winter sports.