Surgery News - August 2007 - (Page 19)

AUGUST 2007 • SURGERY NEWS FINANCE COVERING YOUR ASSETS Diversification Tips for Financial Success “Don’t gamble; take all your savings and buy some good stock and hold it till it goes up, then sell it. If it don’t go up, don’t buy it.” —Will Rogers he three main steps to building a successful portfolio—asset allocation, diversification, and rebalancing—were presented in the first of this three-part series, with emphasis on allocation (see July 2007, p. 23). While asset allocation is a form of diversification, the term diversification more typically refers to having multiple individual holdings within an asset class, to avoid concentrating money in just a few stocks, bonds, or other entities. On average, this mixture yields higher returns and poses a lower risk than any individual investment in the portfolio. Along with BY CHARLES D. diversification MABRY, M.D., FACS within a type of stock or bond, investing outside the United States is a diversification technique. Although equity and bond markets are loosely correlated across the globe, differences in the economies of these countries help to reduce risk. What are the various asset classes, and how can you ensure diversification in your portfolio? Equities. Stocks represent ownership in a company and usually depend on the company’s growth and earnings to gain in value. The amount of stock that is outstanding times the share value determines the market capitalization rate of the company (often abbreviated to “cap”). Companies are divided into categories by their market cap, as well as by their growth or valuation characteristics, usually with terms such as large-cap growth or smallcap value companies. There are other types of companies, such as utility companies, that are bought primarily for the dividends they pay, providing more diversification. The market cap is typically $300 million to $2 billion for small-cap stocks, $2-$10 billion for mid-cap stocks, and $10-$200 billion for large-cap stocks. With growth stocks, earnings are expected to increase at an above-average rate relative to the market, while value stocks are characterized by a high dividend yield, a low price-to-book ratio, and/or a low price-to-earnings ratio. These equities are sold on U.S. exchanges (New York Stock Exchange or NASDAQ) or, if the companies are foreign, on exchanges in other countries. A wise investment includes a blend of all of these stocks, and a mixture of industries that the stocks represent. For instance, you could buy large-, mid-, and small-cap stocks as well as foreign equities, all of which are invested in petroleum production—and not have achieved any meaningful diversification. Bonds. When you loan money to a corporation, government, or country, you have purchased a bond. Bonds are typically T less risky than stocks. They are used to preserve capital with a guaranteed income stream for most portfolios. They come in all varieties and times to maturity, a mixture of which likewise reduces risk. Government bonds are considered the safest of all securities, followed by corporate bonds. Bond rating companies assign a risk score to these. For example, Standard & Poor’s gives a triple-A (AAA) rating to lowest-risk bonds, and AA or A to low-risk bonds. High-yield bonds (junk bonds, rated BB or lower) are higher risk, but when bought as part of a mutual fund, they may be a useful addition to a portfolio. Real estate, commodities, precious metals. Investments such as these help reduce risk and add return, but they are generally either illiquid or require sophistication, attention, and time to trade successfully. Therefore, most investors hold these types of assets via mutual funds or electronically traded funds. When used judiciously, they help diversify a portfolio. In our next article, we will discuss rebalancing your portfolio to make the most of asset allocation and diversification. ■ DR. MABRY serves on the finance committee and investment subcommittee of the ACS Board of Regents and is the series editor for the ACS Practice Management Course for Residents and Young Surgeons. TYGACIL® (tigecycline) Brief Summary See package insert for full Prescribing Information. For further product information and current package insert, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556. CONTRAINDICATIONS TYGACIL is contraindicated for use in patients who have known hypersensitivity to tigecycline. WARNINGS Anaphylaxis/anaphylactoid reactions have been reported with nearly all antibacterial agents, including tigecycline, and may be life-threatening. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. TYGACIL should be administered with caution in patients with known hypersensitivity to tetracycline class antibiotics. TYGACIL may cause fetal harm when administered to a pregnant woman. If the patient becomes pregnant while taking tigecycline, the patient should be apprised of the potential hazard to the fetus. Results of animal studies indicate that tigecycline crosses the placenta and is found in fetal tissues. Decreased fetal weights in rats and rabbits (with associated delays in ossification) and fetal loss in rabbits have been observed with tigecycline. (See PRECAUTIONS, Pregnancy.) The use of TYGACIL during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown). Results of studies in rats with TYGACIL have shown bone discoloration. TYGACIL should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated. Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including TYGACIL, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated. PRECAUTIONS General Caution should be exercised when considering TYGACIL monotherapy in patients with complicated intra-abdominal infections (cIAI) secondary to clinically apparent intestinal perforation. (See ADVERSE REACTIONS.) In Phase 3 cIAI studies (n=1642), 6 patients treated with TYGACIL and 2 patients treated with imipenem/cilastatin presented with intestinal perforations and developed sepsis/septic shock. The 6 patients treated with TYGACIL had higher APACHE II scores (median = 13) vs the 2 patients treated with imipenem/cilastatin (APACHE II scores = 4 and 6). Due to differences in baseline APACHE II scores between treatment groups and small overall numbers, the relationship of this outcome to treatment cannot be established. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. Such effects may include: photosensitivity, pseudotumor cerebri, and anti-anabolic action (which has led to increased BUN, azotemia, acidosis, and hyperphosphatemia). As with tetracyclines, pancreatitis has been reported with the use of TYGACIL. As with other antibacterial drugs, use of TYGACIL may result in overgrowth of non-susceptible organisms, including fungi. Patients should be carefully monitored during therapy. If superinfection occurs, appropriate measures should be taken. Prescribing TYGACIL in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Information for Patients Patients should be counseled that antibacterial drugs including TYGACIL should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When TYGACIL is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by TYGACIL or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible. Drug Interactions Prothrombin time or other suitable anticoagulation test should be monitored if tigecycline is administered with warfarin. (See CLINICAL PHARMACOLOGY, Drug-drug Interactions in full prescribing information.) Concurrent use of antibacterial drugs with oral contraceptives may render oral contraceptives less effective. Drug/Laboratory Test Interactions There are no reported drug-laboratory test interactions. Carcinogenesis, Mutagenesis, Impairment of Fertility Lifetime studies in animals have not bee http://www.wyeth.com http://www.wyeth.com

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Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

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