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Preparing for takeoff.(Style health & beauty)
Make sure to keep it comfortable. It used to be travelers "dressed" to board an airplane. Today, comfort takes center stage. It's definitely possible to be comfortable while remaining stylish. And, remember, avoid high heels for airport wear, as you never know when you may need to make a dash for it. Both men and women have come to realize the joy of slip-ons, especially when you pass through that unavoidable security line.
Equally important, don't pack more luggage than you can handle by yourself. Frankly, it's not good travel etiquette to show up needing fellow travelers to help you with your luggage when they have their own bags to deal with. Carry-on should be just that -- what you can personally carry on the aircraft. Checking bags is a different story, but, remember, you still have to get all that luggage to the check-in counter. Here's where wheels can be a lifesaver.
Give yourself more than enough time to get to the airport. There's nothing more stressful than racing through traffic in fear of missing your flight.
And, if you are always hot or cold no matter where you go, remember to layer your clothing when traveling. It's always smart to carry a jacket or sweater when hitting the road.
Drink plenty of waterbefore, during and after boarding the airplane. Hydration is one of the most important health and beauty tips, almost universally agreed upon. And note: Soda, coffee and alcohol can all be dehydrating. Go ahead and enjoy that glass of wine in first class, but follow it with plenty of water.
Don't forget to pack healthy snacks. Nuts, trail mix, power bars and even cut-up vegetables all travel well and can come in handy during layovers or the dreaded delay.
Take along an all-in-one tinted moisturizer and sunscreen. These are lighter than most foundations and work well for travel.
A small bottle of mist-on skin toner can be a refreshing pick-me-up on the plane and in the limo en route to the hotel. And a little dot of rosemary or peppermint oil on the temples is said to relieve congestion.
Don't surrender! As long as it's three ounces or less, and in a one-quart "Ziploc" bag, your fragrances and cosmetics are coming along for the ride. And carrying a couple of extra Ziplocs isn't such a bad idea. Who knows, you may be the center of a random act of kindness, helping out a less-prepared fellow traveler.
While it's true that travel has become more challenging over the past several years, with security lines, delays and packing restrictions, it can still be an enjoyable experience with a little flexibility and planning.
Markets in health care: the case of renal transplantation.(SYMPOSIUM)
Introduction
Recent developments in organ procurement have revived the much-debated role of markets in our health care system. (1) The unique American health care system, with its presumption of universality alongside private health insurance and relatively limited federal and state programs, is in many ways consumer-driven today. We certainly tolerate more broad disparities in availability of care and in outcomes of care largely based on socioeconomic status than do many other developed countries, where notions of universal access are supported by broader public financing.
However, for the last 30 years, trenchant advocates of the market, especially those in legal academia such as Clark Havighurst and Richard Epstein, have argued for more consumer choice and, indirectly, a distribution of health care resources based on ability to pay. (2) They are not advocates of inequality, but rather of the efficiency associated with the market, and indirectly of the ability of the market to remove powerful monopolists from control of the industry, such as physicians, hospitals, and insurers. Their opponents, the majority of health policy experts, fear that inequity in access will worsen with more market incentives. The two perspectives of the debate are well practiced, not only in health care, but generally in politics, where the tension between those who emphasize liberty and market choice and those who attempt to guarantee reasonable distributions within a liberal context has dominated for the last half century. (3)
However, with the aid of the Internet, efforts in this country to increase the number of available organs, especially for renal transplantation, have provided a new lens for review of this old debate. (4) These new developments highlight the choices we face in our health care system today. Given the affordability challenges of a burgeoning health care system and the unraveling health care safety net, the timeliness of this article on the issues of the market in organs could not be more propitious.
The Failing Market
It is easy to understand why market advocates are drawn to allocations of organs, in particular kidneys: The facts speak for themselves. At present more than 60,000 people are on the waiting list for a kidney. Their chances of survival and their quality of life would be much improved if they could obtain a donated kidney. Unfortunately, only 15,000 people per year are transplanted, while 5,000 people on the list die each year. (5) And the list continues to grow.
The problem could be solved if there were more living donors, a proposition that necessitates a discussion on the various types of donors. One class of donors is the recently dead, providing so-called "cadaver donations:' These are kidneys harvested from people under a variety of federal and state laws that outline the role of family consent. The United Network for Organ Sharing (UNOS) controls the supply of cadaver kidneys, and the allocation is based on notions of equity and need. Indeed UNOS, like the World Health Organization (WHO), eschews any purchase of organs, (6) which eliminates at least for now the issue of a market in organs arising with cadaver organs.
Living donors comprise the second class of organs, and these fall into several categories of importance to this discussion. We should recognize first, however, that living donor transplantations are a significant issue primarily in renal transplantation because the single kidney remaining after donation is usually sufficient for the donor's own survival. The same is not true with hearts or pancreases. Livers can be partially donated, but significant health issues have begun to present themselves for donors as well as recipients. Thus, we restrict the living donor discussion to kidneys and examine the several classes that exist within that framework.
First, relatives may donate their own organs to those afflicted with disease, in this case renal disease. This class is well recognized, as it involves both familial love and altruism. However, advances in immunology and the increasing ability to circumvent rejection of the transplanted organ are slowly supplanting the need to have relatives provide closely matched kidneys. Instead, the focus has turned to stranger donations, which again brings to the fore the place where strangers go to transact business: the market.
Before discussing the market in purchased kidneys, a second category of living donors merits attention: those people with an altruistic commitment to others' welfare. Relatively few in number, they represent a fascinating human impulse, but for the moment do not hold significant policy implications as they are relatively rare.
The third category of living donors are not "donating: Rather, they wish to sell their kidneys. Simply put, an advocate of markets in health care would argue that it is a reasonable exchange for an entrepreneur who donates a kidney to receive payment. The availability of organs would increase as a result of this type of arrangement, and at least those able to pay would be removed from the transplant list. More lives would be saved, and participants would be happy, and even grateful, for this market exchange. Those unable to purchase would nonetheless move up the list as the purchasers moved off of it.
Of course, several other permutations in this category of donors exist. Presumably a central financial authority could pay for the kidney from tax revenues, such as Medicare's End Stage Renal Disease Program (ESRD) for dialysis and transplant services. Recent analysis suggests that the government could save money with this approach so long as the purchase price was less than $90,000. This interesting policy consideration might represent an alternative to much of what is discussed later in the paper, but we leave it aside for now as it does not represent the key issue in the debate about a market in organ procurement.
The category of living, selling donors has two important subsets with two potential sources of organs: American citizens in the United States, and foreigners, especially from developing countries. We focus first on the latter as the ethical issues in kidney sales become more apparent if one moves to an international focus where the inequities created, or at least tolerated, by the market are greater.
Just as labor in developing countries is cheaper, so might be the cost of a kidney donated by someone in a developing country, as emerging literature on purchased kidneys has revealed. The market advocate would find nothing surprising or wrong with this empirical observation. Valuations are based on one's own circumstances in the marketplace, and the market should operate in all industries in a trans-national fashion. With this as background, we can plunge forward in understand the political, philosophical, and ethical issues that a market in organs presents.
However, one final footnote remains: the Internet. One can imagine that a market in living-donor produced kidneys could develop through entrepreneurial activities, relying on word of mouth or the media. However, the Internet solves many problems surrounding communication and the pairing of willing donors and recipients; it brings them together in a very efficient fashion. In addition, the Internet knows no national boundaries, so it promotes an international market. Thus, the emergence of MatchingDonors.com, for example, heralds the beginning maturation of the market, just as market advocates would expect. (7) So our examination of these issues is timely indeed.
Just Distributions and Maximized Utilities
The contours of the political philosophy that underlie most Western countries (known as liberalism) have been widely discussed, and the numerous views of its appropriate structure depend on the importance that various observers attach to autonomy, rights, duties, efficiency, and equality. (8) The poles of the spectrum are clear: the Nozickian libertarian and the Rawlsian liberal. For the Nozickian libertarian, the only role of the government is to provide the police, who ensure that individual liberty is not interfered with and to allow the market to operate without impingement. Individual rights are celebrated insofar as they buttress individual autonomy. The justice of this society is guaranteed with the supposition that all have equal access to the market, and inequalities that develop are tolerated in that everyone has a chance to thrive. In some renditions of libertarianism, a primary condition of equality is posited, and inequities that develop subsequently are the result of fair competition.
At the other end of the spectrum, the Rawlsian liberal is concerned about distributions--inequitable distributions are unjust. She would identify certain primary social goods, such as education, housing, and food, and these primary social goods would be subject to some governmental oversight so that they would not be inappropriately distributed. Again using the fiction of a primary condition in which principles of governance are identified, those in this original position would contract to have inequality governed or reduced by some controls on individual autonomy.
The differences are clear. Nozick favors unfettered markets and cannot accept taxes whereas Rawls allows taxes to help level access to primary social goods, which creates a regulated market. In this regard, health care would be a primary social good and not be simply distributed through the marketplace. In many ways, Canada's health care system represents something that Rawls would applaud, with central financing and no market purchases. The United States, on the other hand, has a health care system that tends more toward some free market, libertarian approaches.
Interestingly, however, these two ends of the liberalism spectrum share a commitment to utilitarianism. Nozick praises John Stuart Mill's belief that the greatest good is supported by the individual's free choice: the pluralist view that the summation of individual enterprise is greater than what any one person or group of persons could produce through central planning. Hence the affinity to the market: the U.S. overcame the U.S.S.R., and the market overcame central planning. Along with this commitment to efficiency comes acceptance of uneven income distributions in order for a polity (or economy) to flourish, which produces some millionaires as a byproduct.
Rawls and modern liberals would not argue with the importance of utilitarianism. The creation of the greatest good is still of most importance. However, they believe that individuals in an original position would be willing to accept regulation to balance distributions, because to some extent they are risk adverse. Along another, perhaps more communitarian line, however, they realize that for society to operate efficiently, some sense of allegiance must exist, which is promoted not simply by justice as fairness, but also by just distributions. This sense of justice, imbued in society by reasonable distributions of primary social goods, is important enough to compromise some efficiency through curbs on market impulses. With this background, we can proceed to the living donor discussion.
The Living Donor Calculus
In these terms then, the acceptability of an unrelated, living donor transplantation takes the form of a simple equation. The easily identified utilities include the quality-adjusted life years that are increased for those with renal failure who received transplants, and the useful actions that donors undertake with the money they receive in return for their (spare) kidney. The donors' costs are whatever negative health repercussions that might be experienced as a result of the donation, but they could be reconciled, in aggregate at least, by their enjoyment of the revenue. We may also be concerned about some systemic aspects of allowing a market in organs, which we might term a corruption of altruism. But let us first examine the benefits and costs of donation in more detail.
The first component includes the benefits to recipients and is in many ways the easiest. Clearly, there are health benefits to increasing the number of transplantations that exist. But recent analysis suggested that the Medicare End Stage Renal Disease Program itself could spend as much as $90,000 per kidney and still spend less overall on health care than in the current state. (9) And such an analysis, focusing at it does on the costs for the Medicare program, incorporates few of the quality-adjusted life years that would be enjoyed by recipients. Thus, the utility of more transplants is significantly positive.
The costs of transplant for the donor are thought to be rather modest despite some disability at the time of donation. An increase in risk of end stage renal disease does occur, but the risk is relatively small, especially if the donor is healthy and not at risk for certain diseases like hypertension or diabetes.
Such risks (and the potential costs associated with them) are balanced directly by the payment to the kidney donor. While some people may not be capable of evaluating the risks, the vast majority of individuals facing this question would be able to weigh the pros and cons. Those concerned about these prospective donors' ability to judge could apply some relatively non-burdensome regulation: a floor on payments; specific literature on costs for donors; required counseling by certified individuals before the transplant operation; and required contribution to an insurance plan in case of subsequent renal disease or other complications. All of this suggests that even with minimal regulation, a very positive utility function could be realized.
Yet a slightly more fine-grained analysis might indicate some deficiencies. First, we should separate international from strictly American transfers. Transplanting a kidney from someone in India, for example, would be one way to ensure a positive utility function from an American viewpoint. The cost of the kidney is likely to be much lower in an impoverished country, just as the costs of labor are, and the Indian health care system would endure the negative health repercussions, not the American one. Perhaps the kidney itself could be harvested in India and flown in time to the United States, further reducing logistics costs. Thus, the benefits would remain the same, while the costs would be much lower.
The preceding example invokes the concept of distributive justice. Research has demonstrated that indeed the cost of a kidney in India is very low, around $1,000. (10) But those who have donated kidneys do not find themselves lifted out of poverty. In addition, they incur significant health care costs associated with subsequent illnesses and would not recommend a donation to others in hindsight. Consequently, those in India benefit little, but those in the United States benefit a great deal. While the strict libertarian is not disturbed by this prospect, especially if the foreign donor made an informed decision, certainly a Rawlsian liberal must acknowledge the injustice of the export of costs and import of utilities. Moreover, the relative inequity of knowledge and power between recipients and their brokers, on one hand, and the impoverished donors, on the other, suggests the potential for exploitation (i.e., lack of full information and free choice) that is not reasonable, no matter how maximized the utilities.
So let us now move to the analysis of donations by citizens of the United States. Consider two potential donors: a farmer and an economist. The poor farmer in rural Alabama earns less than $40,000 most years and has a long family history of hypertension and diabetes. Also, a reasonable number of the members of his extended family qualify for Medicaid. He would like to sell a kidney to pay off some high interest debt and has been provided with some literature on the risks of donation, but has not read it.
The economist at a major university has made a great deal of money in the purchase and sale of stocks, and would currently like to invest a maximal amount in a start up company with potentially great prospects. He has learned about the possibility of kidney donation on the Internet; can access several brokers to drive the best deal possible; and has read a great deal about the risks of donation. Frankly, he considers the potential monetary costs of the latter risk to be far less than the potential upside of the start up. He also believes that he can buy a specific insurance policy to cover the health risks of donation.
What objections would we have to either donor going forward with a market-based exchange? The risks of a poor health outcome related to donation by the farmer seem higher given his family risks, but would that not be disability-based discrimination? Moreover, the chances of him becoming a burden for others if he becomes ill following donation are higher, but again, would that in itself be a reason to prohibit him from moving forward? Possibly not.
The set of issues surrounding the poor farmer were well outlined nearly ten years ago in a debate between Richard Epstein and Atul Gawande in the online magazine Slate. (11) As they discussed the various ways in which regulation may be needed to modify a pure market, Epstein questioned the implications of the hypothetical donation. To paraphrase him, would we prohibit either the farmer or the economist from providing an altruistic donation of a kidney to a relative? Would not all of our concerns about future costs and lack of understanding of risks be eliminated if the farmer were undertaking an altruistic donation to a family member? If we would not prohibit such gift giving, then how deep can our concerns about externalization of costs be?
Moreover, if the concerns about externalization of costs are dealt with, then what rational basis exists for a regulatory regime that would prohibit the first donor from moving forward, but allow the latter to do so? And is there really any rationale to prohibit the latter, who has addressed all of our utilitarian concerns? The answer seems to be no, unless we take into account that last issue of costs, i.e., those associated with advancing the health care system toward a market-based approach. We now address this issue.
The Market in Health Care and the Approaching Storm
It is clear today that the levee system in New Orleans should have been the target of a $20 billion upgrade over the course of the 1990s. Hurricanes had returned to historical force. The city was slowly sinking, and the existing system of flood controls could have kept Lake Pontchartrain out of the city only if an approaching storm was grade three or less. Many experts saw the possibility of a catastrophe. But it was easier to ignore it. (12)
So too are some very weak aspects of our health care system easily ignored. The population is aging quickly, with a huge influx of retirees coming into Medicare coverage within the next ten years. The ratio of workers to retirees will fall significantly; meanwhile physicians and hospitals will find new ways to expend resources to treat people. Managed care, which was arguably an effective cost constraint mechanism, has been receding for years. Insurers are struggling to identify new mechanisms for reducing costs and improving quality. Experts have advocated pay for performance in its place, but so far more money is being spent on consultants who can explain this concept than the amount being saved by these programs. We have few effective ways to reduce provider-induced demand, and we are therefore headed toward a health care cost crisis.
Governments and businesses (the payers) bear these costs. Insurers and providers have failed largely to develop real cost control mechanisms upon which purchasers can rely. Because we cannot effectively reduce unnecessary care or eliminate waste in the system, the only answer that payers have is to provide less coverage for those they do insure, or insure fewer people. The calculus is as simple as the prediction that a storm like Katrina could and would devastate
New Orleans.
What kind of health care system do we envision in the future based on these trends? It is an ugly picture. Medicare will have to reduce its benefits structure. The only alternative to under-insurance is to pay hospitals and doctors less, which raises the concern that many providers will no longer care for Medicare recipients. The specter of the two classes of care between government and private payers will be reinforced by similar moves by Medicaid programs. This state/federal program for the poor will probably be more likely to simply decertify patients as recipients, adding significantly to the rolls of the uninsured. These uninsured will be joined by those previously insured through private employment, whose benefits will have been reduced or more likely removed by employers who can no longer afford the costs of premiums. Some states like Massachusetts may be able to get close to universal access with an individual mandate, but many others with narrower Medicaid programs will not be able to do so.
Hospitals could grow strategic in a rather wretched way. They will reduce their emergency service access so as to limit the portal for the uninsured to gain access. Depending on payer mix, some will drop out of federal programs and serve only the insured. Nonetheless, they will be strapped as the cross-subsidies on which they relied are reduced. They will also face competition from surgicenters and surgical hospitals, which will be much more nimble in accumulating insured patients and well-compensated procedures.
The wealthy will still receive the same care, but with more therapy tailored to the specific genomic determinants of disease. However, the lower-middle class person will struggle to get access, and the poor will have to rely on a tattering safety net. In the mix will be the well-heeled individuals with renal disease who have purchased organs.
Fortunately, this is not the market or health care system today, but it is the one in which we could find ourselves. And the context for sales of kidneys will be changing as well. ESRD is currently lubricated by federal funds through the Medicare system, the only disease group that is treated in such a fashion. Indeed, it was the impulse toward egalitarianism that led to federal funding in the first place, as policy makers in the early 1970s could not bear to witness young people dying from a treatable disease because they could not afford dialysis.
In a more hard-edged future, this commitment will not to be obtained. The ESRD will likely be unaffordable in its present form. We will face not simply the matter of hidden morbidity as the poor stay on dialysis, and the rich are transplanted, but rather, the poor, at least some of them, will die of renal failure while others (most likely the poor) donate kidneys to the wealthy. The poor farmer noted earlier will not have the safety net of Medicaid to fall back on should his health matters go poorly. Or the act of donation will be a way to buy health insurance because the market in this context would not be the floral vision of entrepreneurs and innovation, but rather one of very hard and ugly choices, made by desperate people. And in this system, the impulses of altruism and commitment that should characterize a healthy system of care are lost.
An Alternative Approach
I have both utilitarian--and justice-based concerns about the sale of kidneys in the future health care state as outlined above. Perhaps it is easiest to first examine justice and its accompanying concept, virtue. Consider the following from the perspective of both the provider and patient. We expect that health care providers will follow a code of ethics, a code that is deeply based in notions of altruistic commitment to the good of the patient. (13) We as a society depend on this commitment and, in individual circumstances, expect it.
How long can this virtue of altruistic commitment endure in an ever sharper marketplace? The nephrologist and the transplant surgeon will know that the only transplants will be for those wealthy enough to afford it. How long can they maintain the belief that every person, every patient is of inestimable value? If society lets the poor remain on dialysis unless they have a relative with a kidney (in this case, the cadaver harvesting system having ceased as a cost control measure in an impoverished Medicare system), will not the general commitment to patient welfare be corroded?
Patients will also be uneasy. They will know that their care depends on their ability to pay. Will they be able to trust their caregivers, or is the doctor-patient relationship only as thick (or thin) as the cash nexus? The patient is in a vulnerable position, and she must depend on the physician for wisdom and advice--but can she do so when market values alone dominate? Will the market's efficiency compensate for the loss of a caring community?
The utilitarian perspective follows closely. Sometimes virtue, although spawned from quite different motivations and rationales, does produce useful outcomes. The impulse to care for everyone, whether supported in Canada by broad taxation or in the United States by an intricate system of cross-subsidies, does serve the purpose of creating a common goal of healing that is independent of social class. It is a humane industry, and there are likely quantifiable benefits in this approach. Without reverting to the original position, or to a majoritarian analysis, we can still speculate that the leveling of health care undertaken by the virtuous commitment to the patient, serves everyone well. It creates a sphere of virtue that must create significant utilities.
So the alternative is to provide universal care to all patients, a proposal that has long been on the policy table, but rarely addressed seriously. Moreover, the problem with demographics outlined above means that a universal commitment would require that all would have to accept somewhat less. The first step would be to eliminate unnecessary care, but the second step would be to explicitly ration. Other countries do this today, keeping their percentage of gross national product (GNP) devoted to health care lower than ours by implicitly or explicitly restricting care--the number of MRI and CT scanners in Canada amplify this point. We would have to do the same, or at least we would have to show a rational approach to restrictions on care that is equitable.
This is where the issue of paying for kidneys provides a great paradigm for the future. One possible future has been outlined above: a market driven approach where a trade in kidneys benefits the wealthy. Another might offer promise of a utilitarian, just, and virtuous health care system.
In the market approach, we recognize that costs of the ESRD would be lower if we could do more transplants; therefore, we would encourage more. However, we do not want to reduce costs through an unfettered marketplace, which would introduce more inequity and undermine more virtue than we could tolerate. For both utilitarian- and justice-based reasons, we might avoid a hard turn to the unfettered market.
So we turn return the regulated market mentioned briefly above. Why could the ESRD not start paying for living donor transplants? (14) They could offer a reasonable price; could provide counseling and assessment for every one interested in offering a kidney; and could distribute the kidneys in an equitable fashion to those most in need. The savings involved could be used to weather the coming storm, and to ensure that the dialysis program continued for those not offered kidneys. The just distribution of the kidneys would enhance the virtue of the health care system, and market incentives would be used rationally. Could the utility of this approach really be much less than a completely free market?
This proposal makes essentially two points. First, it accepts the market advocate's position that we need to begin exploring those prohibitions on market activities that are mere taboo. Market incentives to donate kidneys will help increase the supply of kidneys, which will in turn decrease health care costs, and in my perspective, we have a moral responsibility to decrease costs. But we do not want to do so in a way that undermines our basic commitment to the patient as a person. We do need to maintain and protect the virtue of health care, but market incentives and virtues can co-exist in a regulated public market.
Second, any current policy proposals must be made not with the presumption, which is as broad as it is unstated, that resources will always grow in health care. Soon, we may face real needs to cut back, and we must do so in a way that maintains our virtuous health care system. Pure market innovations, which eschew all regulation toward equality, lead us in the direction of a calamity when a period of true health care inflation-created scarcity occurs.
The sale of kidneys illustrates this well. I believe that such sales by living donors can be important and quite necessary, but they must be regulated and occur under the auspices of a public authority. Without this control, we are on a steep slope toward an inequitable health care system that we will likely rue creating.
References
(1.) R. Steinbrook. "Public Solicitation of Organ Donors," New England Journal of Medicine 353, no. 5 (2005): 441-44; F. L. Delmonico, "Exchanging Kidneys--Advances in Living-Donor Transplantation" New England Journal of Medicine 350 (2004): 1812-4; R. D. Truog, "The Ethics of Organ Donation by Living Donors; New England Journal of Medicine 353, no. 5 (2005): 444-6.
(2.) See e.g., R. Epstein, Mortal Peril (Chicago: Addison Wellesley, 1997).
(3.) Many of the papers outlining these positions are cited in T. A. Brennan, Just Doctoring: Medical Ethics in the Liberal State (Berkeley, CA: University of California Press, 1991).
(4.) A. Drukker, "Payment for Organ Donation: Unacceptable or a Possible Solution?" IPNA 18 (2003): 198-199; M. M. Friedlaender, "The Right to Sell or Buy a Kidney: Are We Failing Our Patients?" The Lancet 359, no. 1: 971-73.
(5.) See Delmonico, supra note 1.
(6.) See Steinbrook, supra note 1.
(7.) Id.
(8.) See supra note 3.
(9.) A. J. Matas and M. Schnitzler, "Payment for Living Donor (Vendor) Kidneys: A Cost-Effectiveness Analysis," American Journal of Transplantation 4, no. 2 (2004): 216-221.
(10.) M. Goyal, R. L. Mehta, L. J. Schneiderman, and A. R. Sehgal, "Economic and Health Consequences of Selling a Kidney in India," JAMA 288, no. 13 (2002): 1589-92.
(11.) A. Gawande, "Letting People Peddle Their Kidneys Might Save Lives, but the Ethical Price Is Too High" Slate, 1998, available at
Dirt and the body politic.(first word)
The first thing I thought when I heard about toxic chemicals in personal care products was, "Well, I'm probably okay, I use a lot of Body Shop products."
But there they were, on the label of The Body Shop peppermint foot cream I rub into my feet at night: methylparaben, propylparaben, ethylparaben, butylparaben, isobutylparaben.
Parabens, in case you haven't heard, are the new lead. Parabens are used to prolong the life of products that might otherwise go mouldy before you had a chance to use them. Like formaldehyde, an ingredient in nail polish and many personal care products, parabens are associated with birth defects, infertility, endometriosis and developmental disabilities in children. And yet most of us wipe them on our armpits, or into our scalps, and slather them onto our face, hands and feet.
All five parabens in my foot cream are considered possible endocrine disruptors that pose potential breast cancer risks, according to the Environmental Working Group's online personal care product database, Skin Deep, which ranks the safety of 14,000 personal care products (www.ewg.org/reports/skindeep2/report.php).
I know what you're thinking: Women shouldn't use cosmetics--problem solved. However, even if women stopped using camouflage-type cosmetics, the toxin problem would still persist, since most of us still brush our teeth, bathe and want a deodorant that won't kill us.
We already know that long-term exposure to chemicals that act as endocrine-disruptors affects our breast cancer risk. Our female bodies are especially sensitive to torqued-up estrogen receptors because there are more fat cells for estrogen-mimickers to glom onto. We're already trying to get rid of endocrine-disrupting chemicals in pesticides and in broken-down plastics, and to reduce our exposure to hormones in drugs like HRT. And now--this.
I'm tempted to take a bath and relieve my stress using the Lush bath products I recently received as a gift. Lush oozes uncorporateness with its cool chunk soaps and wholesome ingredients--or so I thought. It turns out that my Lush Comforter Bubble Bar Slice contains sodium lauryl sulfate, titanium dioxide and a red dye that's red-flagged by Skin Deep. Sodium lauryl sulfate has been known to become contaminated with 1,4-dioxane, considered a probable carcinogen by the U.S. Food and Drug Administration.
The good news, if it can be called that, is that none of these ingredients are among the 22 recently banned in the European Union. The not so good news is that Canada's new requirement that ingredients to be listed (see Misha Warbanski's feature article in this issue) cannot be interpreted as evidence of safety, because most have never been tested.
I'm curious, so I check to see what Skin Deep thinks of my toothpaste, Tom's of Maine. It is ranked better than a few, but it is disheartening to find out that a company I thought was a groovy little mom and pop shop is owned by Colgate-Palmolive. I buy Tom's because it is available sans fluoride (a carcinogen and bone-wrecking agent I drink plenty of in my tap water) and boasts baking soda. But Tom's hasn't signed the Safe Compact Cosmetic pledge, and so I ask Skin Deep to recommend some better brands.
What to do with all of this information? Support companies that have signed the Safe Compact pledge. The Body Shop has agreed to phase out ingredients likely to be toxins, but I've put them on waivers for now. Bert's Bees has a better product list and, along with Kiss My Face, has signed on. I'll try Crystal Body deodorant.
If you feel the need to paint your toes peering through those Birkenstocks this summer, check out Skin Deep first for some safer brands, and don't use nail hardeners--they rank as some of the worst products. Phthalates, a class of industrial plasticizers invented in the 1930s, make nail polish flexible. Lab animals given dibutyl phthalate had higher numbers of offspring with birth defects of the male reproductive system. Perfumes are not only unessential but brimming with chemicals, including phthalates, to make them release scent slowly.
Breast Cancer Action Montreal is leading the way in Canada. Until we see more action on safety, use the interactive product safety guide on Skin Deep to choose products free of known cancer-causing ingredients or impurities.
As feminists, our political strength lies in taking collective action to affect change. The cosmetics industry profits handsomely from sexist beauty standards, and a reckless approach to regulation just doesn't wash.
The ugly side of the beauty industry
Take a look around your bathroom. The average North American woman uses 10 or more personal-care products every day. From toothpaste and soap to antiperspirant and moisturizer, personal care products are made from 10,500 chemical ingredients that are as much a part of our daily routine as sitting down to breakfast. And like most things that happen before a mug of morning coffee, it's easy not to think about them too much.
But researchers and women's health activists are sounding the alarm bell about the makeup of makeup. Women and girls are particularly susceptible to exposure to certain chemicals that mimic hormone activity. Because our bodies have a greater percentage of fat in comparison to men, chemicals that are fat-soluble are more easily absorbed. Breast tissue is one such site where chemicals can accumulate.
"As more and more women are diagnosed with cancer, we have to question, where is this all coming from?" posits Carol Secter, a board member of Breast Cancer Action Montreal. With an emphasis on breast cancer prevention, Secter's group is part of a North America-wide movement to have harmful chemicals banned from personal care and household products.
Increasingly, science is pointing out that exposure to many of these chemicals--including parabens used to preserve antiperspirants and creams, and phthalates added to perfumes and nail polish--may harm our health. A 2004 study of breast tumours by Dr. Phillippa Darbre, from the University of Reading in the U.K., and published in the Journal of Applied Toxicology, found parabens in each of 20 samples. This led researchers to suspect that parabens, which mimic estrogen when absorbed through the skin, may play a role in the development of breast cancer. The researchers suspected the parabens came from underarm deodorants; however, they concluded that more research is needed. While parabens aren't restricted in Canada, many manufacturers are going paraben-free because of consumer demand.
Now banned in the European Union, phthalates are another common ingredient in personal care products suspected in a variety of health problems from liver malfunction to low testosterone levels and low sperm counts in men. In 2002, researchers in Chicago tested 72 brand-name cosmetics and found that 52 contained phthalates, a compound that helps cosmetics stay put without smudging. Phthalates are also used to make perfumes and soaps. Scientists suspect the absorption of cosmetics through the skin could explain why young women in one study had 20 times the level of phthalates in their body compared to young men.
Seventy years ago, the first cosmetics law in the U.S. banned the use of coal tar dye in mascara after the ingredient was found to cause blindness. Today, the accumulation of chemicals found in personal care products may affect men and women's offspring. In August 2005, researchers, including University of Rochester epidemiologist Shanna Swan, published the first study to examine prenatal exposure to phthalates. The study found that the development of the genitals of boys whose mothers had high levels of phthalates in their bodies was less complete compared to those exposed to lower levels. Swan believes phthalate exposure may be contributing to increasing rates of male infertility and testicular cancer.
In response to a growing concern about the risks associated with personal care products, Health Canada now requires personal care product manufactures to list product ingredients by the end of the year. The department also maintains a hotlist of already restricted and banned chemicals. The hotlist was expanded in 2003 from less than 100 to almost 500 after reviewing some chemicals that are restricted in the E.U. However, no independent testing is done prior to a new product hitting the shelves in Canada-manufacturers are only required to submit a list of product ingredients. This is just one reason critics are demanding that the precautionary principle be imposed on Canada's $3.5-billion personal care industry.
"There is no review to ensure the list on the label is accurate," says Madeleine Bird, a researcher at McGill University's Centre for Research and Teaching on Women.
Bird cites a Danish study on parabens that discovered that contents listed on a product's label were different from the makeup of the product, which sometimes had much higher concentrations. "Some check and balance is needed," adds Bird.
However, health activists say harmful chemicals shouldn't be there, period. Formaldehyde, benzene and lead are associated with not only cancer, but endometriosis, birth defects and developmental disabilities in children. Coal tars used in hair dye have long been associated with liver cancer. Petroleum distillates, a suspected human carcinogen banned in the E.U., are still in use in North America.
[Graphic omitted] According to the Washington-based Environmental Working Group, 89 percent of ingredients in personal care products have never been assessed for safety. Breast Cancer Action Montreal figures Canada would be roughly similar, as ingredients were grandfathered into use in Canada without being tested for safety. Under the 1999 Environmental Protection Act, Health Canada and Environment Canada are reviewing more than 23,000 chemicals that were never tested for safety.
Until recently, the contents of personal care products have been a mystery. While the Canadian government requires food manufacturers to list ingredients on packaging, cosmetics and personal care products have historically been exempt. Last November, Canada caught up with the United States and European Union and will require the contents of personal care products to be labelled by the end of the year. Retail outlets and manufacturers were given a year's grace to sell off unlabelled products. Still, Dr. Samuel Epstein, coauthor of The Safe Shopper's Bible and head of the Cancer Prevention Coalition, has said that the labelling will be meaningless to anyone without a pharmacology degree.
Secter agrees. "I don't want to go shopping for my body products, my cosmetics, with a chemical dictionary telling me this one's okay, this one's not. I want to be able to walk in and buy it off the shelf with the understanding that it's safe."
In Europe, Secter would be better protected. The European Union bans more than 1,100 chemicals from personal care products because they may cause cancer, birth defects or reproductive problems. In stark contrast, just nine chemicals are banned from cosmetics in the United States; Canada follows U.S. standards. Women in California won a recent victory with the passage of the Safe Cosmetics Act, which takes effect later this year. The law compels manufacturers to disclose product ingredients if they are on state or federal lists of chemicals associated with cancer and birth defects. Importantly, California's bill also contains provisions designed to protect the safety of nail-salon and cosmetology workers who handle solvents, chemical solutions and glues.
In the rest of North America, governments remain slow to regulate, so activists and consumers are taking the matter into their own hands, using the power of the pocketbook to pressure companies to change their formulas.
"Information is something that can be very empowering," says Bird, who completed her degree in women's studies and is now working to raise awareness about chemicals so that individuals can reduce their own exposure, seek out alternatives and demand change.
Abby Lippman, a professor of epidemiology at McGill University, says the answer for her is simple: "If you can't say it, don't wear it." Although not using cosmetics may seem like a simple answer, Lippman doesn't expect most women will suddenly stop using them.
"I don't want to make women who are wearing makeup sound like victims when they're making a conscious decision," says Lippman, who is also a member of Breast Cancer Action Montreal. "But when they make a conscious decision, I want them to be able to be aware of what they're putting on their bodies, and I want them to have access to the safest products. We need good choices, not just an array of some worse than others."
Deciding which products are safest can be a time-consuming task. Designed to make those decisions easier, the Environmental Working Group's Skin Deep report created a searchable database of personal care products and ingredients. The Working Group's information looks at American brands and formulas, most of which are sold in Canada. The group created fact sheets that identify which chemicals and which companies to avoid. Revlon, Estee Lauder, Avon, L'Oreal and Johnson & Johnson are ranked in the group's top 20 of concern. Chanel cosmetics are not tested on animals, but the group gives them the number two rating of brands to avoid, citing a lack of safety data available for the ingredients used. In 2006, The Body Shop announced it would phase out the use of phthalates from its products and packaging, but the company still uses parabens, which are not among the 37 top ingredients of top concern on Skin Deep's list.
With its custom shopping list feature, Skin Deep provides consumers with information to enable them to choose the safest products. The website offers suggestions on where to find that elusive non-toxic lipstick or deodorant and lists over 300 companies that either don't use harmful chemicals or have pledged to eliminate ingredients related to cancer, birth anomalies or hormonal disruption within three years. Companies like The Body Shop, Burt's Bees and Afterglow Cosmetics have signed on. However, the industry's major players such as Avon, Estee Lauder, L'Oreal, Revlon and Proctor and Gamble, are notably absent.
According to the Environmental Working Group cosmetics report, hair colour, nail polish and nail treatments contain some of the most toxic chemicals. One product in particular, OPI natural nail strengthener, received the highest hazard rating of all 14,100 products in the database. The company's nail polish and nail treatments contain toluene, formalde-hyde and dibutyl phthalate--three of the top ingredients of concern.
Of particular concern are products aimed at black consumers that promise lighter skin and straighter hair. Not only do these products impose a white standard of beauty that is harmful, but many hair relaxers and skin lighteners contain ingredients linked to cancer, early puberty and other ailments. For example, hydroquinone, a skin whitener, is deemed a carcinogen by the E.U. While not permitted in Canada in cosmetics, hydroquinone is available in products classified as drugs in Canada. Black women under 40 have a higher breast cancer incidence compared to white women of a similar age, and studies have noted that many of these products are used starting in childhood, prolonging exposure.
The cosmetics industry says it can regulate itself and lobbies for fewer, not more, regulations. Organizations like Breast Cancer Action Montreal aren't waiting for industry to change its practices voluntarily. That's why the organization has launched letter-writing campaigns to four cosmetics companies--Unilever, Johnson & Johnson, Avon and Estee Lauder--the big names that have been stubborn about changing their ingredients. Until we can get all toxic ingredients banned from personal care products, a generous application of consumer pressure may be our best bet.
Online Resources:
The Environmental Working Group's Skin Deep Report:
www.ewg.org/reports/skindeep2
Campaign for Safe Cosmetics:
www.safecosmetics.org
Cosmetic Ingredient Hotlist:
www.hc-sc.gc.ca/cps-spc/person/cosmet/hotlist-liste_e.htm
What's In Your Bathroom?
If personal care ingredients are not listed, you can request content information from the manufacturer. Check the Environmental Working Group's Campaign for Safe Cosmetics report Skin Deep to get details on specific ingredients and to find safer products. Hotlisted ingredients in Canada may be subject to limitations in their concentration or can still turn up in products categorized as drugs, like antiperspirant and anti-dandruff shampoos.
These are some ingredients you may want to avoid:
LEAD ACETATE Found in some hair dye, and cleansers, lead acetate is hotlisted in Canada and banned in the E.U. Lead acetate is a reproductive and developmental toxin.
FORMALDEHYDE Found in some nail products, antibacterial soaps and foundations, formaldehyde is a carcinogen restricted in Canada.
TOLUENE Found in some nail polish and hardeners. It is suspected of being a reproductive or developmental toxin. One form, Toluene-2,4-diamine, is prohibited in Canada.
PARABENS A class of preservatives commonly found in moisturizers, deodorants and many personal care products. Methlyparaben, butlyparaben, isobutylparaben and propylbaraben are classed as endocrine disruptors in Skin Deep.
PETROLEUM DISTILLATES Found in mascara, perfume, lipstick and foundation, petroleum distillates are a suspected carcinogen.
COAL TAR Found in dark hair dyes and antidandruff shampoo, coal tars are carcinogenic and permitted in hair dyes in Canada when accompanied by a warning.
DIBUTYL PHTHALATE Found in nail products. All phthalates are banned in the E.U., but not restricted in Canada. Dibutyl phthalate is an endocrine disruptor and suspected to reproductive toxin.
Source: Environmental Working Group Campaign for Safe Cosmetics
Booby traps back on market.(breast implants)
DESPITE SERIOUS health concerns about their safety, Health Canada granted licences to two manufacturers late last fall to put silicone breast implants back on the market. Silicone implants were withdrawn from sale in North America in 1992 when implant maker Dow faced a class action suit on behalf of implant recipients.
At the same time as the U.S. and Canada decided to give the plastic surgery industry a boost, Dr. Edward Melmed, a Texas-based surgeon who used to perform breast implant surgery, had a change of heart. In response to the debilitating complications experienced by many of his patients, Melmed now refuses to insert silicone implants, but he does remove them. In the process, he has documented a litany of complaints--rock-hard breasts, disfigurement, joint and muscle pain, hair loss, chronic fatigue and depression--many of which cleared up when the implants were removed.
Health Canada doesn't deny that such problems exist. In fact, the licence it issued for breast implants is a "Class IV licence," the highest risk category for an approved medical device.
Implant manufacturers are expected to conduct large, long-term studies involving tens of thousands of women to measure any possible link between silicone implants and rheumatological symptoms, neurological disease, effects on lactation and offspring, and cancer and suicide rates.
[Graphic omitted] In the meantime, manufacturers convinced the U.S. Food and Drug Administration and Health Canada that silicone implants are new and improved. Key studies submitted as evidence of this included research on the effects of the devices for less than three years. And yet long-term research from hundreds of sources over the last two decades suggests that most implants deteriorate, rupture or leak in less than a decade--about the time it takes autoimmune diseases to develop.
Despite a technical ban, silicone implants have actually been sold all along. Health Canada, heading off possible liability questions, required women to sign a waiver acknowledging that they understood silicone implants were experimental.
In light of the high rupture rates and the potential migration of silicone into women's lymph nodes and organs, the U.S. FDA gave the implants a clean bill of health, while recommending that all women undergo regular MRI exams to monitor for breaks.
The $2,000 price tag on MRI screenings--not typically covered by private medical insurers--constitutes a significant cost for U.S. patients. It may also explain why Canada, with its publicly funded system, declined to require such a precaution.
Studies in Canada and elsewhere have shown that women who have implants use the health care system seven to 10 times more frequently than other women, and are hospitalized four times more often. This suggests that they are less healthy than other women.
Meanwhile, Radio Canada reported that three out of four surgeons failed to fully disclose the risks of silicone implants to prospective patients. In the past year, dangerous levels of platinum were discovered in breast milk of women with implants. And a European study found a potential link between implants and immune disease.
The death care industry: a review of regulatory and consumer issues.
Although virtually every person in the United States will purchase or consume a funeral-related product or service, relatively little is understood about the processes a consumer undertakes in making these expensive decisions in stressful circumstances. Regulation of the industry has been contentious from the outset, and there have been numerous questions as to regulatory effectiveness. This article outlines and discusses issues related to the death care industry with particular attention to consumer interests.
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Nearly every person in the United States will purchase or consume a funeral-related product or service for themselves or on behalf of someone else. There were approximately 2.4 million deaths in 2003 in the United States, and by 2040, it is projected that this number will nearly double as members of the Baby Boom generation begin to die (National Center for Health Statistics 2006). Funerals are among the most expensive purchases many consumers will ever make (Federal Trade Commission [FTC] 2000a). Most often, a consumer goes through the decision making for this complex, expensive process once, so that there is little experience, and often few sources of information are used (FTC 2000a). Those making funeral decisions may be under time pressure and significant emotional duress, so that they may be considered vulnerable (Gentry et al. 1995). As a result of this, the funeral industry is regulated at the state and federal levels.
The purpose of this article is to present a review of consumer protection and regulatory issues related to the death care industry. First, we provide a brief description of the products and services that have come to compose the "death care industry." In part because of changes in consumer preferences and in part because of regulation, there are more choices available to consumers. At the same time, this diversification of the industry has led to its own set of problems, including disparities in regulation and enforcement. Next, we discuss the development of the industry in the United States, including the emergence of consumer activism and government regulation. Although funeral homes were not regulated at the federal level until 1984, the consumer issues of cost and the need for consumer protection have been recognized since the birth of the industry. We then discuss the specifics of federal regulation and the challenges of its implementation. Finally, we provide a discussion of consumer issues and offer insight from consumer research literatures that might help in examining the effectiveness of regulation as well as provide direction for research. Evaluative research that attempts to determine the extent to which the impact of the death care regulation has had on consumers would be instrumental in providing additional direction for policy.
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Nearly every person in the United States will purchase or consume a funeral-related product or service for themselves or on behalf of someone else. There were approximately 2.4 million deaths in 2003 in the United States, and by 2040, it is projected that this number will nearly double as members of the Baby Boom generation begin to die (National Center for Health Statistics 2006). Funerals are among the most expensive purchases many consumers will ever make (Federal Trade Commission [FTC] 2000a). Most often, a consumer goes through the decision making for this complex, expensive process once, so that there is little experience, and often few sources of information are used (FTC 2000a). Those making funeral decisions may be under time pressure and significant emotional duress, so that they may be considered vulnerable (Gentry et al. 1995). As a result of this, the funeral industry is regulated at the state and federal levels.
The purpose of this article is to present a review of consumer protection and regulatory issues related to the death care industry. First, we provide a brief description of the products and services that have come to compose the "death care industry." In part because of changes in consumer preferences and in part because of regulation, there are more choices available to consumers. At the same time, this diversification of the industry has led to its own set of problems, including disparities in regulation and enforcement. Next, we discuss the development of the industry in the United States, including the emergence of consumer activism and government regulation. Although funeral homes were not regulated at the federal level until 1984, the consumer issues of cost and the need for consumer protection have been recognized since the birth of the industry. We then discuss the specifics of federal regulation and the challenges of its implementation. Finally, we provide a discussion of consumer issues and offer insight from consumer research literatures that might help in examining the effectiveness of regulation as well as provide direction for research. Evaluative research that attempts to determine the extent to which the impact of the death care regulation has had on consumers would be instrumental in providing additional direction for policy.
BACKGROUND
The death care industry generates over $25 billion in sales annually (Mooney 2002). There are about 22,000 businesses in the United States that perform funeral services (U.S. Census Bureau 2004). The average cost of a funeral is over $8,500 (National Funeral Directors Association [NFDA] 2005), although funeral and burial costs combined may reach $10,000 (AARP 2004). Consumer preferences, competition, and technology have continued to drive changes in this industry.
To better understand the consumer protection issues surrounding the death care industry, it is useful first to define what composes the "industry." The death care industry can be divided into five primary components (General Accounting Office [GAO] 2003): (1) funeral homes, (2) crematories, (3) cemeteries, (4) preneed sales of funeral plans, and (5) third-party sales of funeral goods. What has historically been a fragmented group of discrete product or service providers has ultimately become a group of businesses that often compete with one another by offering the same products or services but operate under different sets of regulations at the state and federal levels.
Funeral Homes
There are approximately 16,000 funeral homes in the United States, which generate over $11 billion in revenue (U.S. Census Bureau 2004). Eighty-nine percent of these funeral homes are owned by individuals, families, or closely held private corporations, averaging sixty-six years in business. The remaining 11% of funeral homes is owned by one of five publicly held corporations (NFDA 2005). Approximately three-quarters of deaths in 2001 were casketed and had some form of ritual or ceremony (Casket & Funeral Supply Association 2005).
Several trends currently affect this portion of the death care industry. There have been changes in consumers' beliefs as to what is considered a "traditional" funeral. Consumers have begun to request more personalized services, so that funeral homes offer a greater variety of secondary services, including "aftercare" services and support groups, community referrals, and libraries. Additionally, many states have increased the educational requirements to acquire and retain a funeral director's license (NFDA 2005).
Crematories
A growing number of Americans are opting for cremation as a method of disposition, although enthusiasm for the practice is not new (The Modern Cremation Movement 1912). According to the Cremation Association of North America, there are over 1,800 crematories in the United States. Cremation was used in about 31% of deaths in 2004, and it is projected that over 50% will use cremation by 2025 (Cremation Association of North America 2006). Use of cremation varies widely with geography, ranging from over 67% in Hawaii to less than 10% in Alabama and Mississippi (Cremation Association of North America 2006).
Responses to a benchmark national survey conducted in 1999 suggested that Americans are choosing cremations because they are less expensive, use less land (environmental considerations), are simpler, and are convenient (Wirthlin Group 1999). Cremation has also been subject to recent changes in consumer preferences for alternative funerals and memorials. Cremated remains can be incorporated into underwater "reef" memorials, turned into fireworks, shot into space, turned into diamonds, or enclosed in keepsake jewelry.
Cemeteries
There are approximately 115,000 cemeteries in the United States (Roane 2002), consisting of four basic types (Cochrane 2002):
(1) National: usually for military veterans and direct family.
(2) Public: municipally owned and operated.
(3) Religious: nonprofit which are exclusive to a religion.
(4) Commercial: owned and operated as a business for profit.
The prices for graves can vary substantially depending on location. Normally, graves in urban centers are more expensive than those in rural centers. In recent years, many cemeteries have transformed from selling only burial plots to providing more services, thus competing directly with traditional funeral homes (Selected Independent Funeral Homes 2005). Until recently, the majority of cemeteries were owned by nonprofit groups such as churches and municipalities, but many cemeteries are now being purchased by for-profit corporations (Carlson 1998). Cemeteries are regulated exclusively at the state level.
Preneed Sales of Funeral Plans
The preneed, or prearranging, concept originated with burial organizations in the 1930s. There is a distinct difference between "preplanning," which involves the consumer's decision making regarding the specifics of a funeral, and "prepurchase," or "preneed" agreements, the proceeds of which are used toward funeral and other expenses. Funeral industry proponents tend to emphasize that prepurchase is helpful since there is then money dedicated toward funeral expenses (NFDA 2005). Consumer advocates discourage prepurchase, and instead encourage preplanning, which allows people to decide in advance what type of funeral they will have but pay at the time of death (Fleck 2002; Funeral Consumers Alliance 2005). Preneed agreements are likely to include a package for funeral and burial goods and services and may be sold by funeral directors and cemeterians. Consumers have purchased in advance an estimated $25 billion in funeral goods and services through funeral homes or insurance companies (Hermanson 2000).
In most states, only licensed funeral home directors and cemeteries are allowed to sell preneed contracts, but some states allow for the sale of preneed agreements by third-party sellers, as long as they obtain a permit or license (AARP 1999).
Third-Party Sales of Funeral Goods
Third-party vendors are neither funeral homes nor cemeteries, and usually sell a very narrow line of funeral merchandise, including caskets or urns. Third-party sellers purport to offer lower prices than traditional funeral homes for individual products and perhaps because of this, have become a growing segment of the death care industry (FTC 2002c). It is estimated that 25% of U.S. families are expected to use a third party to purchase funeral products for a loved one by 2020 (Rybarski 2004). Because third-party vendors are not "traditional" sellers of funeral products, they may not fall under either state or federal death care regulation domains.
All of these industry segments have come into being in the United States over roughly the past two centuries. Although different death cares practices were brought to the United States from different countries and cultures (Mandelbaum 1976; Moore and Bryant 2003), consumer protection efforts have come to focus primarily on a fairly mainstream ritual for disposition of the dead. To fully understand the dynamics of the death care industry, and the consumer and regulatory issues that surround it, it is useful to examine its history.
EMERGENCE OF THE DEATH CARE INDUSTRY IN THE UNITED STATES
Death was a commonplace but grim experience in the young United States (Smith and Hacker 1996). The death rate was high, and the Puritans believed in a personal mortality in which death provided an escape from an uncomfortable life. Small communities fostered primary relationships and required mutual reliance, so that upon someone's death, family and friends prepared the body for disposition. The body was interred either in a family plot on the farm or in the churchyard. Funerals were very public and social functions (Bowman 1959).
During the nineteenth century, funeral services were conducted in the home of the deceased. The undertaker brought all the supplies and equipment (often embalming was carried out in the home). Religious services were held at the home or in church, after which the funeral concluded with a procession to the cemetery. It was among the undertaker's assignments to remove all signs of the funeral from the home while the family attended the procession, so that the family had no work to do upon returning. The undertaker's role was primarily the construction of the coffin and to provide some basic assistance (Carlson 1998).
Changing demographics and new technologies in embalming were the primary drivers for change in the way families "cared" for their dead. Occupational mobility and the decline of the extended family led to families' living in smaller houses. It was therefore not always possible for families to use the home as the gathering place for the funeral ceremony (Pine 1975). The technology in embalming that had been developed during the Civil War became more sophisticated (Laderman 1996; Pine 1975). This meant that the equipment used was more difficult to bring to a private home, so that eventually, undertakers began to provide facilities to accommodate the entire ritual. A room of the funeral establishment was supplied to families; this became the "funeral parlor." This combination of activities, along with funeral counseling, contributed to the development of the "funeral director" as a professional occupation and the "funeral home" as a retail provider of professional services. Gradually, the funeral home became the dominant location for preparation of the body, the wake service, and eventually the burial (Bowman 1959).
The death care industry generates over $25 billion in sales annually (Mooney 2002). There are about 22,000 businesses in the United States that perform funeral services (U.S. Census Bureau 2004). The average cost of a funeral is over $8,500 (National Funeral Directors Association [NFDA] 2005), although funeral and burial costs combined may reach $10,000 (AARP 2004). Consumer preferences, competition, and technology have continued to drive changes in this industry.
To better understand the consumer protection issues surrounding the death care industry, it is useful first to define what composes the "industry." The death care industry can be divided into five primary components (General Accounting Office [GAO] 2003): (1) funeral homes, (2) crematories, (3) cemeteries, (4) preneed sales of funeral plans, and (5) third-party sales of funeral goods. What has historically been a fragmented group of discrete product or service providers has ultimately become a group of businesses that often compete with one another by offering the same products or services but operate under different sets of regulations at the state and federal levels.
Funeral Homes
There are approximately 16,000 funeral homes in the United States, which generate over $11 billion in revenue (U.S. Census Bureau 2004). Eighty-nine percent of these funeral homes are owned by individuals, families, or closely held private corporations, averaging sixty-six years in business. The remaining 11% of funeral homes is owned by one of five publicly held corporations (NFDA 2005). Approximately three-quarters of deaths in 2001 were casketed and had some form of ritual or ceremony (Casket & Funeral Supply Association 2005).
Several trends currently affect this portion of the death care industry. There have been changes in consumers' beliefs as to what is considered a "traditional" funeral. Consumers have begun to request more personalized services, so that funeral homes offer a greater variety of secondary services, including "aftercare" services and support groups, community referrals, and libraries. Additionally, many states have increased the educational requirements to acquire and retain a funeral director's license (NFDA 2005).
Crematories
A growing number of Americans are opting for cremation as a method of disposition, although enthusiasm for the practice is not new (The Modern Cremation Movement 1912). According to the Cremation Association of North America, there are over 1,800 crematories in the United States. Cremation was used in about 31% of deaths in 2004, and it is projected that over 50% will use cremation by 2025 (Cremation Association of North America 2006). Use of cremation varies widely with geography, ranging from over 67% in Hawaii to less than 10% in Alabama and Mississippi (Cremation Association of North America 2006).
Responses to a benchmark national survey conducted in 1999 suggested that Americans are choosing cremations because they are less expensive, use less land (environmental considerations), are simpler, and are convenient (Wirthlin Group 1999). Cremation has also been subject to recent changes in consumer preferences for alternative funerals and memorials. Cremated remains can be incorporated into underwater "reef" memorials, turned into fireworks, shot into space, turned into diamonds, or enclosed in keepsake jewelry.
Cemeteries
There are approximately 115,000 cemeteries in the United States (Roane 2002), consisting of four basic types (Cochrane 2002):
(1) National: usually for military veterans and direct family.
(2) Public: municipally owned and operated.
(3) Religious: nonprofit which are exclusive to a religion.
(4) Commercial: owned and operated as a business for profit.
The prices for graves can vary substantially depending on location. Normally, graves in urban centers are more expensive than those in rural centers. In recent years, many cemeteries have transformed from selling only burial plots to providing more services, thus competing directly with traditional funeral homes (Selected Independent Funeral Homes 2005). Until recently, the majority of cemeteries were owned by nonprofit groups such as churches and municipalities, but many cemeteries are now being purchased by for-profit corporations (Carlson 1998). Cemeteries are regulated exclusively at the state level.
Preneed Sales of Funeral Plans
The preneed, or prearranging, concept originated with burial organizations in the 1930s. There is a distinct difference between "preplanning," which involves the consumer's decision making regarding the specifics of a funeral, and "prepurchase," or "preneed" agreements, the proceeds of which are used toward funeral and other expenses. Funeral industry proponents tend to emphasize that prepurchase is helpful since there is then money dedicated toward funeral expenses (NFDA 2005). Consumer advocates discourage prepurchase, and instead encourage preplanning, which allows people to decide in advance what type of funeral they will have but pay at the time of death (Fleck 2002; Funeral Consumers Alliance 2005). Preneed agreements are likely to include a package for funeral and burial goods and services and may be sold by funeral directors and cemeterians. Consumers have purchased in advance an estimated $25 billion in funeral goods and services through funeral homes or insurance companies (Hermanson 2000).
In most states, only licensed funeral home directors and cemeteries are allowed to sell preneed contracts, but some states allow for the sale of preneed agreements by third-party sellers, as long as they obtain a permit or license (AARP 1999).
Third-Party Sales of Funeral Goods
Third-party vendors are neither funeral homes nor cemeteries, and usually sell a very narrow line of funeral merchandise, including caskets or urns. Third-party sellers purport to offer lower prices than traditional funeral homes for individual products and perhaps because of this, have become a growing segment of the death care industry (FTC 2002c). It is estimated that 25% of U.S. families are expected to use a third party to purchase funeral products for a loved one by 2020 (Rybarski 2004). Because third-party vendors are not "traditional" sellers of funeral products, they may not fall under either state or federal death care regulation domains.
All of these industry segments have come into being in the United States over roughly the past two centuries. Although different death cares practices were brought to the United States from different countries and cultures (Mandelbaum 1976; Moore and Bryant 2003), consumer protection efforts have come to focus primarily on a fairly mainstream ritual for disposition of the dead. To fully understand the dynamics of the death care industry, and the consumer and regulatory issues that surround it, it is useful to examine its history.
EMERGENCE OF THE DEATH CARE INDUSTRY IN THE UNITED STATES
Death was a commonplace but grim experience in the young United States (Smith and Hacker 1996). The death rate was high, and the Puritans believed in a personal mortality in which death provided an escape from an uncomfortable life. Small communities fostered primary relationships and required mutual reliance, so that upon someone's death, family and friends prepared the body for disposition. The body was interred either in a family plot on the farm or in the churchyard. Funerals were very public and social functions (Bowman 1959).
During the nineteenth century, funeral services were conducted in the home of the deceased. The undertaker brought all the supplies and equipment (often embalming was carried out in the home). Religious services were held at the home or in church, after which the funeral concluded with a procession to the cemetery. It was among the undertaker's assignments to remove all signs of the funeral from the home while the family attended the procession, so that the family had no work to do upon returning. The undertaker's role was primarily the construction of the coffin and to provide some basic assistance (Carlson 1998).
Changing demographics and new technologies in embalming were the primary drivers for change in the way families "cared" for their dead. Occupational mobility and the decline of the extended family led to families' living in smaller houses. It was therefore not always possible for families to use the home as the gathering place for the funeral ceremony (Pine 1975). The technology in embalming that had been developed during the Civil War became more sophisticated (Laderman 1996; Pine 1975). This meant that the equipment used was more difficult to bring to a private home, so that eventually, undertakers began to provide facilities to accommodate the entire ritual. A room of the funeral establishment was supplied to families; this became the "funeral parlor." This combination of activities, along with funeral counseling, contributed to the development of the "funeral director" as a professional occupation and the "funeral home" as a retail provider of professional services. Gradually, the funeral home became the dominant location for preparation of the body, the wake service, and eventually the burial (Bowman 1959).
Along with other occupations in the late nineteenth century, undertakers in major cities began to form professional associations that would provide them with mutual protection as well as set standards for the operation of their trade. The first formal organization of undertakers was the Undertakers Mutual Protective Association of Philadelphia, founded in 1864. Similar groups were formed in several other states, until 1882, when the NFDA was formed (Habenstein and Lamers 1981). Other segments of the death care industry that formed trade organizations around this time included the National Burial Case Association (1881), Monument Builders of North America (1906), and the Cremation Association of America (1913) (Habenstein and Lamers 1981).
As the funeral home emerged as the primary service provider for the preparation and disposition of the dead, the need to control this growing industry became necessary. At the end of the nineteenth century, states began enacting licensing legislation to regulate the practice of embalming. State boards of health started to require burial permits, cremation permits, and death certificates. It was observed early on that the state laws were not uniform (Stueve 1940). So, in addition to the technological, occupational, and social changes affecting what was becoming an "industry," the twentieth century brought about regulatory pressures that contributed to the growth of undertaking as a professional specialty. At the same time, resistance in the form of consumer advocacy groups began to increase.
As the funeral home emerged as the primary service provider for the preparation and disposition of the dead, the need to control this growing industry became necessary. At the end of the nineteenth century, states began enacting licensing legislation to regulate the practice of embalming. State boards of health started to require burial permits, cremation permits, and death certificates. It was observed early on that the state laws were not uniform (Stueve 1940). So, in addition to the technological, occupational, and social changes affecting what was becoming an "industry," the twentieth century brought about regulatory pressures that contributed to the growth of undertaking as a professional specialty. At the same time, resistance in the form of consumer advocacy groups began to increase.
CRITICISMS OF DEATH CARE INDUSTRY AND CONSUMER ACTIVISM
Throughout the past century, numerous observers were critical of the funeral industry. Puckle (1926) proposed that the funeral was a vestige of the superstitious fear of the dead that was characteristic of pagan or primitive societies. In 1928, the Bureau of Labor Statistics called for "reform within the industry ... as well as a different attitude among the people at large for the ostentation involved in needlessly high-priced funerals" (174). Eventually, these complaints led to action.
The People's Memorial Association of Seattle, organized in 1939 by two church groups, was the first urban group to engage in collective funeral planning. "Memorial societies" were formed as a result of the dissatisfaction that many had for the emphasis funeral directors placed on elaborate funerals and the exorbitant fees charged for them. Many joined funeral-planning societies to reduce costs through cooperative buying power, but a sense of social activism permeated the membership (Funeral Consumers Alliance 2005).
Two seminal articles written a decade apart censured the death care industry for deceptive and misleading practices. Davidson (1951) accused undertakers of raising and fixing prices and castigated the trade associations for their political lobbying strength. Tunley's (1961) article incited commentary from over 6,000 Americans who wrote to the Saturday Evening Post to recount their "bitter experiences at the hands of funeral directors" (Mitford 1963).
By the 1960s, critics negatively depicted U.S. business practices in general (Caplovitz 1967; Carson 1962; Nader 1965); this included those who disapproved of the funeral industry and its dealings with consumers (Bowman 1959; Harmer 1963; Mitford 1963; Morgan 1962). These critics observed that American death practices were among the most lavish and costly in the world and argued for changing the way the dead were commemorated. Most significant of these was Jessica Mitford's The American Way of Death (1963). Mitford declared that funeral directors were using unethical selling practices to persuade consumers that a "high standard of living" should be associated with a "high standard of dying."
The book quickly became a bestseller and was instrumental in focusing journalistic attention to the industry nationwide. A U.S. Senate hearing in 1964 brought complaints to the level of federal regulatory consideration (Subcommittee on Antitrust and Monopoly 1964). So, Mitford and her colleagues had increased awareness of industry practices, but concrete outcomes in the form of regulation were not immediate.
Throughout the past century, numerous observers were critical of the funeral industry. Puckle (1926) proposed that the funeral was a vestige of the superstitious fear of the dead that was characteristic of pagan or primitive societies. In 1928, the Bureau of Labor Statistics called for "reform within the industry ... as well as a different attitude among the people at large for the ostentation involved in needlessly high-priced funerals" (174). Eventually, these complaints led to action.
The People's Memorial Association of Seattle, organized in 1939 by two church groups, was the first urban group to engage in collective funeral planning. "Memorial societies" were formed as a result of the dissatisfaction that many had for the emphasis funeral directors placed on elaborate funerals and the exorbitant fees charged for them. Many joined funeral-planning societies to reduce costs through cooperative buying power, but a sense of social activism permeated the membership (Funeral Consumers Alliance 2005).
Two seminal articles written a decade apart censured the death care industry for deceptive and misleading practices. Davidson (1951) accused undertakers of raising and fixing prices and castigated the trade associations for their political lobbying strength. Tunley's (1961) article incited commentary from over 6,000 Americans who wrote to the Saturday Evening Post to recount their "bitter experiences at the hands of funeral directors" (Mitford 1963).
By the 1960s, critics negatively depicted U.S. business practices in general (Caplovitz 1967; Carson 1962; Nader 1965); this included those who disapproved of the funeral industry and its dealings with consumers (Bowman 1959; Harmer 1963; Mitford 1963; Morgan 1962). These critics observed that American death practices were among the most lavish and costly in the world and argued for changing the way the dead were commemorated. Most significant of these was Jessica Mitford's The American Way of Death (1963). Mitford declared that funeral directors were using unethical selling practices to persuade consumers that a "high standard of living" should be associated with a "high standard of dying."
The book quickly became a bestseller and was instrumental in focusing journalistic attention to the industry nationwide. A U.S. Senate hearing in 1964 brought complaints to the level of federal regulatory consideration (Subcommittee on Antitrust and Monopoly 1964). So, Mitford and her colleagues had increased awareness of industry practices, but concrete outcomes in the form of regulation were not immediate.
PRELUDE TO FEDERAL REGULATION
The path to federal regulation of the funeral industry was met with opposition immediately. Following the initial Senate hearings in 1964, another eleven years passed before the FTC issued its intent to develop some type of regulatory parameters (FTC 1975), and then another nine years before any formal boundaries were implemented. In 1973, the Commission began a formal nationwide investigation with a pilot funeral price survey in the District of Columbia, finding wide price variances among funeral homes (FTC 1974). This led to the conclusion that there were "many serious abuses of consumers by large numbers of the nation's 22,000 funeral homes and ... [there is] an urgent need ... for remedial action" at the federal level (FTC 1975, 2). Following its proposal, the Commission was "inundated with paper" (McChesney 1990, 22), receiving thousands of comments from individual funeral directors, trade associations, state governments, and members of industries peripheral to the funeral industry (47 Fed. Reg. 42,260 [1982]).
A Final Notice of Rulemaking was published in February 1976 (41 Fed. Reg. 7787), and much further commentary ensued. Concurrently, the FTC Improvements Act of 1980 (Pub. L. No. 96-252 [section] 19; Riegel 1981) was passed, which directly limited the power of the Commission to regulate without complying with elaborate rulemaking procedures affording the public a chance to comment before final rules could be promulgated; this compelled the Commission to republish its Final Notice (46 Fed. Reg. 6976, 1981) and further comments were received (Fed. Reg. 42,262-63). Finally, in 1984, the Funeral Industry Practices Rule, or Funeral Rule, was put into effect.
THE FUNERAL RULE
Currently, funeral home activities are regulated under the Funeral Industry Practices Rule of the FTC (16 CFR Part 453). As discussed above, the Rule is premised on the assumption that careful, informed purchase decisions in this expensive product category are difficult because of the emotional stress, time pressure, and lack of familiarity with the available goods and services. Based on these assumptions, the Funeral Rule prohibits funeral homes from certain practices and compels funeral homes to perform others.
Specifically, the Funeral Rule prohibits the following:
* Misrepresenting that embalming is legally required or necessary 'when it is not). * Misrepresenting that a casket is required for direct cremation.
* Misrepresenting that any funeral goods or services have protective or preservative abilities (when this is not the case).
* Charging for embalming without permission to perform the service.
* Subjecting consumers to "tying" arrangements--requiring a consumer to purchase any funeral good or service as a condition of purchasing any other good or service.
The Funeral Rule asserts that
* Consumers have the right (with some exceptions) to choose the funeral goods and services they want.
* Funeral providers must state this right in writing on the general price list (GPL).
* If state or local law requires the purchase of any particular item, the funeral provider must disclose it on the price list, with a reference to the specific law.
The most significant of Funeral Rule requirements is the GPL. Funeral homes are required to provide three price lists: the GPL, the casket price list, and the outer burial container price list. The GPL must be given to anyone who asks, in person, about funeral goods, funeral services, or the prices of such goods or services. The Rule explicitly requires that the pricing information also be provided over the telephone. An amendment to the Funeral Rule in 1994 further prohibited the funeral provider from refusing or charging a fee to handle a casket purchased elsewhere and asserted that funeral providers offering cremations must make alternative containers available.
Funeral providers are required to itemize prices of the sixteen specific goods or services shown in Appendix 1. Three of the required prices are related to the transportation of remains; four are related to services involving the disposition of the body. Six of the prices are associated with the funeral home equipment, facility, or staff, while two of the required prices are directly related to the burial container.
The path to federal regulation of the funeral industry was met with opposition immediately. Following the initial Senate hearings in 1964, another eleven years passed before the FTC issued its intent to develop some type of regulatory parameters (FTC 1975), and then another nine years before any formal boundaries were implemented. In 1973, the Commission began a formal nationwide investigation with a pilot funeral price survey in the District of Columbia, finding wide price variances among funeral homes (FTC 1974). This led to the conclusion that there were "many serious abuses of consumers by large numbers of the nation's 22,000 funeral homes and ... [there is] an urgent need ... for remedial action" at the federal level (FTC 1975, 2). Following its proposal, the Commission was "inundated with paper" (McChesney 1990, 22), receiving thousands of comments from individual funeral directors, trade associations, state governments, and members of industries peripheral to the funeral industry (47 Fed. Reg. 42,260 [1982]).
A Final Notice of Rulemaking was published in February 1976 (41 Fed. Reg. 7787), and much further commentary ensued. Concurrently, the FTC Improvements Act of 1980 (Pub. L. No. 96-252 [section] 19; Riegel 1981) was passed, which directly limited the power of the Commission to regulate without complying with elaborate rulemaking procedures affording the public a chance to comment before final rules could be promulgated; this compelled the Commission to republish its Final Notice (46 Fed. Reg. 6976, 1981) and further comments were received (Fed. Reg. 42,262-63). Finally, in 1984, the Funeral Industry Practices Rule, or Funeral Rule, was put into effect.
THE FUNERAL RULE
Currently, funeral home activities are regulated under the Funeral Industry Practices Rule of the FTC (16 CFR Part 453). As discussed above, the Rule is premised on the assumption that careful, informed purchase decisions in this expensive product category are difficult because of the emotional stress, time pressure, and lack of familiarity with the available goods and services. Based on these assumptions, the Funeral Rule prohibits funeral homes from certain practices and compels funeral homes to perform others.
Specifically, the Funeral Rule prohibits the following:
* Misrepresenting that embalming is legally required or necessary 'when it is not). * Misrepresenting that a casket is required for direct cremation.
* Misrepresenting that any funeral goods or services have protective or preservative abilities (when this is not the case).
* Charging for embalming without permission to perform the service.
* Subjecting consumers to "tying" arrangements--requiring a consumer to purchase any funeral good or service as a condition of purchasing any other good or service.
The Funeral Rule asserts that
* Consumers have the right (with some exceptions) to choose the funeral goods and services they want.
* Funeral providers must state this right in writing on the general price list (GPL).
* If state or local law requires the purchase of any particular item, the funeral provider must disclose it on the price list, with a reference to the specific law.
The most significant of Funeral Rule requirements is the GPL. Funeral homes are required to provide three price lists: the GPL, the casket price list, and the outer burial container price list. The GPL must be given to anyone who asks, in person, about funeral goods, funeral services, or the prices of such goods or services. The Rule explicitly requires that the pricing information also be provided over the telephone. An amendment to the Funeral Rule in 1994 further prohibited the funeral provider from refusing or charging a fee to handle a casket purchased elsewhere and asserted that funeral providers offering cremations must make alternative containers available.
Funeral providers are required to itemize prices of the sixteen specific goods or services shown in Appendix 1. Three of the required prices are related to the transportation of remains; four are related to services involving the disposition of the body. Six of the prices are associated with the funeral home equipment, facility, or staff, while two of the required prices are directly related to the burial container.
FUNERAL RULE: IMPLEMENTATION AND CHALLENGES
From its conception, the Rule was met with strenuous resistance that ranged from Congressional action to legal challenges (Kilpatrick 1977; McChesney 1990). Even as the Rule was put into effect, several groups challenged its promulgation on evidentiary, policy, procedural, statutory, and Constitutional bases (Harley & Bryant et al. v. FTC et al. 1984b).
One of the first applications of the Rule was directed toward a funeral home in Texas (FTC v. Hughes 1989). The FTC provided evidence of hundreds of violations of the Funeral Rule, including failure to provide itemized statements to customers, failure to disclose charges, and failure to provide pricing information over the phone. The Hughes Funeral Home was fined $80,000 and was advised that subsequent violations would not only breach the Rule but would also contravene a federal court order (resulting in more severe penalties).
The largest civil penalty in the history of Funeral Rule enforcement was over $121,000 (U.S. v. Restland Funeral Home 1996). The FTC alleged that five funeral homes owned by Restland had violated the Funeral Rule by failing to provide customers with the required itemized information (five of the eight Rule stipulations). Restland settled under a consent decree to pay the fine, to submit their employees to training, and to send a letter announcing the settlement to each consumer who had purchased a preneed plan for funeral goods and services.
Review of the Rule in 1988 revealed that since funeral homes were not allowed to bundle casket sales with funeral services, a market had emerged for casket vendors who often charged substantially less than funeral homes. The FTC ascertained that in response many funeral homes had begun to charge fees for "handling" caskets that were purchased through the third-party vendors. The Commission ultimately adopted an amendment that prohibited funeral homes from charging these "casket handling fees." Again, the funeral directors en masse immediately sought to invalidate the amendment, but their arguments were rejected (Pennsylvania Funeral Directors Association v. FTC 1994).
The debundling requirements of the Funeral Rule led to uncertainty about who was able to provide products and services. Further, as federal resources were limited, the enforcement of both federal and state regulations was increasingly delegated to the states. So, although many states adopted laws based on the Funeral Rule, interpretation of the same terminology and enforcement of the laws could vary across states (Casket Royale v. Mississippi 2000; Oklahoma v. Stone Casket 1998). For example, in Craigmiles v. Giles (2000), a minister who had opened a casket supply store was ordered to cease and desist by the state of Tennessee because he was not a licensed funeral director. Craigmiles sued the state, claiming that the order violated his right to earn a living under the U.S. Constitution. The U.S. District Court brushed off the state's arguments that the licensing was necessary for health and consumer protection, suggesting instead that the 1972 requirement had been intended to reduce competition among funeral directors. The federal appellate court agreed (Craigmiles v. Giles 2002).
However, the same licensing requirements have been supported in other states, depending on the product, service, or channel of distribution (Guardian Plans v. Teague 1989; National Funeral Services v. Rockefeller 1989; Oklahoma v. Stone Casket 1998). Most significantly, a state licensing law very similar to that challenged in the Craigmiles case was upheld in Oklahoma (Powers v. Harris 2004). The third-party casket seller maintained no physical storefront presence in the state, but instead was selling its merchandise over the Internet. While the FTC filed an amicus brief (FTC 2002b) encouraging the court to allow the casket seller to operate without a license in order to promote price competition, the court discounted this argument in favor of the consumer protection afforded by licensing requirements.
The FTC initially claimed that compliance to the amended Funeral Rule was quite low--less than 50% (FTC 1989). In 1994, the Commission initiated "sweeps" of funeral homes in various states; funeral homes were visited by undercover test shoppers, who would then report whether funeral home personnel complied with the Rule. Particular emphasis was placed on putting the price list in customers' hands at the very beginning of any conversation about products and services. These sweeps have continued as joint enforcement efforts involving states' attorneys general offices and often consumer activist groups (Death Care Business Advisor 1997). The original sweeps resulted in the exposure of numerous funeral homes that failed to adhere to the Rule's strictures. A report from the GAO from data gathered in 1997 and 1998 suggested that compliance had become very high "among the limited sample of homes visited" (GAO 1999).
In conjunction with these sweeps, the Commission developed its first corporate compliance program with a trade association on behalf of an industry, creating the Funeral Rule Offenders Program for funeral homes found to have violated the commission's rules concerning prices and services. Under the program, the FTC and other government agencies would still enforce the rules. However, funeral homes that failed to provide customers with itemized price lists regardless of whether they had requested such lists would be required to make "voluntary" payments to the government and to undergo extensive staff training and testing for five years. The program was administered by the NFDA. More recently, the F-FC has asserted increased compliance with the Funeral Rule (2000, 2002a, 2005), notwithstanding evidence that would suggest the opposite (Funeral Consumers Alliance 2006).
Federal regulation of the funeral industry faced considerable opposition in the early stages of its implementation and enforcement. The focus of compliance as well as the measure of success of the Rule to this point has been twofold: increasing competition for funeral homes by increasing the number and types of sellers of death care services and increasing consumer protection by insuring that funeral homes provide pricing information. However, as discussed in the next section, modifications in the existing regulation may be necessary as changes occur in both consumer preferences and the competitive dynamics of the industry.
From its conception, the Rule was met with strenuous resistance that ranged from Congressional action to legal challenges (Kilpatrick 1977; McChesney 1990). Even as the Rule was put into effect, several groups challenged its promulgation on evidentiary, policy, procedural, statutory, and Constitutional bases (Harley & Bryant et al. v. FTC et al. 1984b).
One of the first applications of the Rule was directed toward a funeral home in Texas (FTC v. Hughes 1989). The FTC provided evidence of hundreds of violations of the Funeral Rule, including failure to provide itemized statements to customers, failure to disclose charges, and failure to provide pricing information over the phone. The Hughes Funeral Home was fined $80,000 and was advised that subsequent violations would not only breach the Rule but would also contravene a federal court order (resulting in more severe penalties).
The largest civil penalty in the history of Funeral Rule enforcement was over $121,000 (U.S. v. Restland Funeral Home 1996). The FTC alleged that five funeral homes owned by Restland had violated the Funeral Rule by failing to provide customers with the required itemized information (five of the eight Rule stipulations). Restland settled under a consent decree to pay the fine, to submit their employees to training, and to send a letter announcing the settlement to each consumer who had purchased a preneed plan for funeral goods and services.
Review of the Rule in 1988 revealed that since funeral homes were not allowed to bundle casket sales with funeral services, a market had emerged for casket vendors who often charged substantially less than funeral homes. The FTC ascertained that in response many funeral homes had begun to charge fees for "handling" caskets that were purchased through the third-party vendors. The Commission ultimately adopted an amendment that prohibited funeral homes from charging these "casket handling fees." Again, the funeral directors en masse immediately sought to invalidate the amendment, but their arguments were rejected (Pennsylvania Funeral Directors Association v. FTC 1994).
The debundling requirements of the Funeral Rule led to uncertainty about who was able to provide products and services. Further, as federal resources were limited, the enforcement of both federal and state regulations was increasingly delegated to the states. So, although many states adopted laws based on the Funeral Rule, interpretation of the same terminology and enforcement of the laws could vary across states (Casket Royale v. Mississippi 2000; Oklahoma v. Stone Casket 1998). For example, in Craigmiles v. Giles (2000), a minister who had opened a casket supply store was ordered to cease and desist by the state of Tennessee because he was not a licensed funeral director. Craigmiles sued the state, claiming that the order violated his right to earn a living under the U.S. Constitution. The U.S. District Court brushed off the state's arguments that the licensing was necessary for health and consumer protection, suggesting instead that the 1972 requirement had been intended to reduce competition among funeral directors. The federal appellate court agreed (Craigmiles v. Giles 2002).
However, the same licensing requirements have been supported in other states, depending on the product, service, or channel of distribution (Guardian Plans v. Teague 1989; National Funeral Services v. Rockefeller 1989; Oklahoma v. Stone Casket 1998). Most significantly, a state licensing law very similar to that challenged in the Craigmiles case was upheld in Oklahoma (Powers v. Harris 2004). The third-party casket seller maintained no physical storefront presence in the state, but instead was selling its merchandise over the Internet. While the FTC filed an amicus brief (FTC 2002b) encouraging the court to allow the casket seller to operate without a license in order to promote price competition, the court discounted this argument in favor of the consumer protection afforded by licensing requirements.
The FTC initially claimed that compliance to the amended Funeral Rule was quite low--less than 50% (FTC 1989). In 1994, the Commission initiated "sweeps" of funeral homes in various states; funeral homes were visited by undercover test shoppers, who would then report whether funeral home personnel complied with the Rule. Particular emphasis was placed on putting the price list in customers' hands at the very beginning of any conversation about products and services. These sweeps have continued as joint enforcement efforts involving states' attorneys general offices and often consumer activist groups (Death Care Business Advisor 1997). The original sweeps resulted in the exposure of numerous funeral homes that failed to adhere to the Rule's strictures. A report from the GAO from data gathered in 1997 and 1998 suggested that compliance had become very high "among the limited sample of homes visited" (GAO 1999).
In conjunction with these sweeps, the Commission developed its first corporate compliance program with a trade association on behalf of an industry, creating the Funeral Rule Offenders Program for funeral homes found to have violated the commission's rules concerning prices and services. Under the program, the FTC and other government agencies would still enforce the rules. However, funeral homes that failed to provide customers with itemized price lists regardless of whether they had requested such lists would be required to make "voluntary" payments to the government and to undergo extensive staff training and testing for five years. The program was administered by the NFDA. More recently, the F-FC has asserted increased compliance with the Funeral Rule (2000, 2002a, 2005), notwithstanding evidence that would suggest the opposite (Funeral Consumers Alliance 2006).
Federal regulation of the funeral industry faced considerable opposition in the early stages of its implementation and enforcement. The focus of compliance as well as the measure of success of the Rule to this point has been twofold: increasing competition for funeral homes by increasing the number and types of sellers of death care services and increasing consumer protection by insuring that funeral homes provide pricing information. However, as discussed in the next section, modifications in the existing regulation may be necessary as changes occur in both consumer preferences and the competitive dynamics of the industry.
CURRENT ISSUES IN REGULATION
Critics have blamed the Funeral Rule for decreasing competition in the market and have made accusations that the Rule was imposed with little basis or systematic inquiry into actual market conditions (Harrington and Krynski 2002; McChesney 1990). At the same time, consumer advocates have viewed penalties levied by the FTC against members of the funeral industry as victories (Hagedorn 1990). Attempts have been made to extend the reach of the Funeral Rule, while there still exist questions as to its effectiveness. Further compounding these questions are fragmenting consumer preferences that encourage nontraditional funeral practices.
When the Funeral Rule was first proposed in 1975, it explicitly applied only to "funeral providers," at the time defined only as funeral homes. As nonfuneral home retailers have emerged, offering narrower product lines and services, which were originally offered only through funeral homes, the Funeral Rule parameters have not applied. For example, cemeteries or other service providers have transformed in recent years from sellers offering single services to full-service funeral providers. These funeral services are similar to those offered by traditional funeral homes but are not covered by the consumer-protective regulations of the FTC.
Funeral home trade associations who have opposed FTC regulation and enforcement for decades have now begun to argue that that the Funeral Rule should be expanded to apply to all industry segments. Calls for extended application of the Rule have been advocated from many corners (AARP 1995; Frank 1996; Horton 2003). According to AARP, tighter regulation of preneed burial and funeral agreements is of particular importance because mishandling of trust funds can go undetected since a significant amount of time may pass from the execution of an agreement and the need for the goods and services delineated in the agreement. In addition, it is difficult to determine whether specific provisions of the contract are fulfilled since the person who signed the contract is more than likely deceased (AARP 1995). So, while the competition-inducing elements of the Funeral Rule were intended to protect consumers, the lack of regulation of other industry segments that has resulted may be counterproductive. Although Congressional proposals would have extended the Funeral Rule to cover all death care businesses (H.R. 4187 [2002]; S. 3023 [2004]), at this writing, no attempts to amend the Funeral Rule are pending.
At a more local level of regulation, many states adopted legislation that used the Funeral Rule as a model (Carlson 1999). But individual states were also the first to feel the consequences of the gaps in federal death care regulation, particularly when incidents occurred that could be attributed to a lack of licensing-related oversight across less-regulated industry segments or to a lack of understanding of how consumers behave in their purchase decision making. In response, several states enacted legislation to control the nonfuneral home businesses. For example, the state of Georgia passed more rigorous controls over crematories (Horton 2003) after a crematorium was found to have piles of rotting corpses on its premises (Washington Post 2003). Other states have refused legislation that would allow third-party casket sales (Oklahoma Funeral Services Licensing Act 1999).
In 2002, the U.S. GAO conducted a study to examine the administrative structures that states used for regulating the death care industry and the mechanisms the states employed for enforcing their regulations (GAO 2003). The report concluded that states tended to regulate funeral homes more than any other segment of the industry, but that states varied significantly in their approaches to and enforcement of regulations. Most states do regulate cemeteries and preneed sales, although the degree of regulation again varies across states. Third-party sales are less regulated than any other segment of the death care industry (GAO 2003).
Further evidence of the differential impact of state regulations on consumer purchase decisions was provided by Harrington and Krynski (2002). They found that states that require funeral directors to be embalmers or that require funeral homes to have embalming preparation rooms tended to have lower cremation rates, suggesting that funeral home directors might be steering consumers away from lower cost cremation services.
An additional issue arises when new technologies are developed or when consumer preferences emerge that may deal with death but are not necessarily related to the death care industry as it is currently defined. Cryonics, for example, may be viewed as an alternate means of disposition of a body (Josias 2004), but the purpose of freezing the body is not for interment but rather for eventual reanimation. In early 2004, a bill was introduced in the Arizona legislature but later withdrawn, which would have required funeral licensing for providers of these services (H.B. 2637; Arizona House of Representatives 2004). States continue to struggle internally with who should regulate the expanding components of the industry (Couch 2006; Galloway 2006).
A higher order issue has also been raised. The funeral ritual has been described as very important in Western culture (Kastenbaum 1992), although it has been criticized for being archaic and unnecessarily expensive. However, previous research has identified what could be considered significantly different rituals among cultures or ethnicities (Kalish and Reynolds 1976; Moore and Bryant 2003) within the United States. This suggests that purchasing behaviors may differ across cultures, such that neither federal nor state protective efforts may capture all of the possible sources of consumer vulnerability.
REGULATION AND THE CONSUMER
Through the preceding discussion, it should become apparent that as the death care industry has developed, it has become increasingly difficult to regulate. In practice, the types of businesses that offer death care services continue to expand; yet, the Funeral Rule as it was somewhat myopically written applies to a decreasing proportion of service providers (funeral homes). States then have to compensate by making decisions about which of the new product categories, retail alternatives or consumer preferences fall under their purview, and then to determine which state-level agency will serve as overseer. It is also an untested assumption that regulatory compliance in this industry is commensurate with regulatory effectiveness.
What is missing from much of the discussion on the efficacy of the Funeral Rule is an understanding of the consumer in this product category. What consumer research literature offers to policy at this point is some insight into consumer behavior, measures of effectiveness of regulation, and direction for further research with respect to (1) information disclosure, (2) the context in which death care products are purchased, (3) the consumer's search for information and evaluation of alternatives, (4) the actual decision making, and (5) the use of consumer complaints and other purchase evaluations as measures of regulatory effectiveness.
Critics have blamed the Funeral Rule for decreasing competition in the market and have made accusations that the Rule was imposed with little basis or systematic inquiry into actual market conditions (Harrington and Krynski 2002; McChesney 1990). At the same time, consumer advocates have viewed penalties levied by the FTC against members of the funeral industry as victories (Hagedorn 1990). Attempts have been made to extend the reach of the Funeral Rule, while there still exist questions as to its effectiveness. Further compounding these questions are fragmenting consumer preferences that encourage nontraditional funeral practices.
When the Funeral Rule was first proposed in 1975, it explicitly applied only to "funeral providers," at the time defined only as funeral homes. As nonfuneral home retailers have emerged, offering narrower product lines and services, which were originally offered only through funeral homes, the Funeral Rule parameters have not applied. For example, cemeteries or other service providers have transformed in recent years from sellers offering single services to full-service funeral providers. These funeral services are similar to those offered by traditional funeral homes but are not covered by the consumer-protective regulations of the FTC.
Funeral home trade associations who have opposed FTC regulation and enforcement for decades have now begun to argue that that the Funeral Rule should be expanded to apply to all industry segments. Calls for extended application of the Rule have been advocated from many corners (AARP 1995; Frank 1996; Horton 2003). According to AARP, tighter regulation of preneed burial and funeral agreements is of particular importance because mishandling of trust funds can go undetected since a significant amount of time may pass from the execution of an agreement and the need for the goods and services delineated in the agreement. In addition, it is difficult to determine whether specific provisions of the contract are fulfilled since the person who signed the contract is more than likely deceased (AARP 1995). So, while the competition-inducing elements of the Funeral Rule were intended to protect consumers, the lack of regulation of other industry segments that has resulted may be counterproductive. Although Congressional proposals would have extended the Funeral Rule to cover all death care businesses (H.R. 4187 [2002]; S. 3023 [2004]), at this writing, no attempts to amend the Funeral Rule are pending.
At a more local level of regulation, many states adopted legislation that used the Funeral Rule as a model (Carlson 1999). But individual states were also the first to feel the consequences of the gaps in federal death care regulation, particularly when incidents occurred that could be attributed to a lack of licensing-related oversight across less-regulated industry segments or to a lack of understanding of how consumers behave in their purchase decision making. In response, several states enacted legislation to control the nonfuneral home businesses. For example, the state of Georgia passed more rigorous controls over crematories (Horton 2003) after a crematorium was found to have piles of rotting corpses on its premises (Washington Post 2003). Other states have refused legislation that would allow third-party casket sales (Oklahoma Funeral Services Licensing Act 1999).
In 2002, the U.S. GAO conducted a study to examine the administrative structures that states used for regulating the death care industry and the mechanisms the states employed for enforcing their regulations (GAO 2003). The report concluded that states tended to regulate funeral homes more than any other segment of the industry, but that states varied significantly in their approaches to and enforcement of regulations. Most states do regulate cemeteries and preneed sales, although the degree of regulation again varies across states. Third-party sales are less regulated than any other segment of the death care industry (GAO 2003).
Further evidence of the differential impact of state regulations on consumer purchase decisions was provided by Harrington and Krynski (2002). They found that states that require funeral directors to be embalmers or that require funeral homes to have embalming preparation rooms tended to have lower cremation rates, suggesting that funeral home directors might be steering consumers away from lower cost cremation services.
An additional issue arises when new technologies are developed or when consumer preferences emerge that may deal with death but are not necessarily related to the death care industry as it is currently defined. Cryonics, for example, may be viewed as an alternate means of disposition of a body (Josias 2004), but the purpose of freezing the body is not for interment but rather for eventual reanimation. In early 2004, a bill was introduced in the Arizona legislature but later withdrawn, which would have required funeral licensing for providers of these services (H.B. 2637; Arizona House of Representatives 2004). States continue to struggle internally with who should regulate the expanding components of the industry (Couch 2006; Galloway 2006).
A higher order issue has also been raised. The funeral ritual has been described as very important in Western culture (Kastenbaum 1992), although it has been criticized for being archaic and unnecessarily expensive. However, previous research has identified what could be considered significantly different rituals among cultures or ethnicities (Kalish and Reynolds 1976; Moore and Bryant 2003) within the United States. This suggests that purchasing behaviors may differ across cultures, such that neither federal nor state protective efforts may capture all of the possible sources of consumer vulnerability.
REGULATION AND THE CONSUMER
Through the preceding discussion, it should become apparent that as the death care industry has developed, it has become increasingly difficult to regulate. In practice, the types of businesses that offer death care services continue to expand; yet, the Funeral Rule as it was somewhat myopically written applies to a decreasing proportion of service providers (funeral homes). States then have to compensate by making decisions about which of the new product categories, retail alternatives or consumer preferences fall under their purview, and then to determine which state-level agency will serve as overseer. It is also an untested assumption that regulatory compliance in this industry is commensurate with regulatory effectiveness.
What is missing from much of the discussion on the efficacy of the Funeral Rule is an understanding of the consumer in this product category. What consumer research literature offers to policy at this point is some insight into consumer behavior, measures of effectiveness of regulation, and direction for further research with respect to (1) information disclosure, (2) the context in which death care products are purchased, (3) the consumer's search for information and evaluation of alternatives, (4) the actual decision making, and (5) the use of consumer complaints and other purchase evaluations as measures of regulatory effectiveness.
Information Disclosure
In other situations in which the provision or disclosure of product information to consumers is mandated through regulation, consumer research has provided some assessment of the effectiveness of the policy. What that research suggests is that consumers often ignore or do not understand disclosure information (Cude 2005; Johnson and Tellis 2005) and thus may not make educated decisions even when the information is provided (Braunsberger, Lucas, and Roach 2005). Day (1976) identified the objectives of information disclosures as "enhancing the consumer's right to know, improving the quality of products and competition, facilitating value comparisons, enabling buyers to better match products and needs and thus increasing purchase satisfaction, and pursuing broad educational aims such as creating general public interest in nutrition or sensitivity to energy conservation" (42). In the case of death care products, one of the explicit purposes of the GPL is to assert the consumer's right to know about alternatives. The impact of the provision of pricing and other information, however, has not been gauged, either in terms of its effect on competition or in terms of its value to consumers.
Purchasing Contexts
There are two primary contexts in which a consumer would normally purchase end of life products or services: at-need and preneed. Consumers tend to resist or avoid making decisions for their own funerals (Wirthlin Group 2005), which then may create either an emergency purchase when they are dying or a situation where a grieving loved one must make the decisions. As noted earlier, time pressure and emotional duress are assumed to be strong influences during at-need decision making. Grief may restrict a person's awareness of whether he or she is being incorrectly charged, or it may limit his or her ability and desire to share information if such practices are experienced. Either of these situations may result in a consumer who is not price sensitive, who is not aware of alternatives, or who may be less aware of the protections afforded by laws (Gentry et al. 1995).
It would follow that given the financial outlay involved in purchasing death care products (Fan and Zick 2004), consumers would engage in more preplanning rather than oblige someone else to make purchase decisions for them (after their demise). Limited direct evidence, however, suggests that consumers have the tendency to ignore or otherwise avoid the consideration of purchasing products associated with death (Kopp and Pullen 2002). A national survey conducted in 2004 reported that 72% of consumers believed prearranging for a funeral to be a good idea, but less than 36% of those consumers had actually done so (Wirthlin Group 2005).
Although taking steps to plan a funeral can be as simple as discussing plans and leaving instructions with family about end of life arrangements--actions that do not involve money--most avoid thinking about or taking even these steps. As a policy alternative, a social marketing approach (Andreasen 1993) would be appropriate to help develop and implement segmentation and targeting strategies to encourage planning behavior. Since individuals are cognizant of the benefits of planning for end of life but many fail to engage in planning activity, learning more about the factors that finally induce action, whether it is reaching a certain age, starting a family, or experiencing the death of a loved one might be helpful in advancing concrete policy actions.
Information Search and Evaluation of Alternatives
Most consumer purchases are a result of nominal or limited decision making and thus involve limited information search immediately prior to purchase (Dickson and Sawyer 1990). Even for major purchases, information search tends to be limited, with the greatest percentage of consumers performing little information search prior to purchase (Urbany, Dickson, and Wilkie 1989; Westbrook and Fornell 1979). Gentry et al. (1995) suggested that when faced with the responsibility of preparing the funeral arrangements for a loved one, grief may render an individual vulnerable and unable to perform the role traditionally expected of a consumer in the market economy. For funeral products and services, an individual's opportunity or propensity to engage in search behavior may be reduced even further by situational factors such as time, health, knowledge of alternatives, or financial resources; in an at-need situation, these factors may not work in the consumer's favor. So, what is generally considered information search by consumers may be further curtailed.
Bundling is a common product strategy used by many manufacturers, retailers, and service providers to differentiate their products and services from competitors. However, bundling or tying was presumed to be a means by which funeral providers could rationalize or disguise costs to consumers or could compel consumers to purchase unwanted items. The debundling element of the Funeral Rule was thus intended to increase competition and seemingly increase consumer choice; it has encouraged the emergence of third-party, nonfuneral home suppliers. For example, warehouse-style retailer Costco recently began piloting the sale of discounted caskets at its retail outlets at a fraction of the cost a consumer would pay at a funeral home (Stiff competition 2004). Internet sites offering caskets, vaults, urns, and other funeral merchandise directly to consumers are now common. Although the rapidly increasing third-party segment of the industry may provide less expensive alternatives to consumers, the availability of more alternatives may not benefit the at-need consumer when he/she may not be rational.
In general, even when bundles have only a few items, the amount of information available for "rational" decision making can be substantial, to the point where consumers may look for ways to simplify the evaluation task (Harris and Blair 2006; Yadav and Monroe 1993). Incorporating all available information into the evaluation of a bundle (e.g., when making an expensive purchase) can be an overwhelming processing task. In this situation, consumers may apply a simplifying heuristic that enables them to approach the evaluation task as a series of smaller or easier evaluations. So in an at-need situation, bundling may actually help consumers. However, this is further reason to encourage preplanning in this product category, since purchasing individual funeral products or services may be less difficult as well as less costly for consumers, the decreased potential for deception notwithstanding.
In other situations in which the provision or disclosure of product information to consumers is mandated through regulation, consumer research has provided some assessment of the effectiveness of the policy. What that research suggests is that consumers often ignore or do not understand disclosure information (Cude 2005; Johnson and Tellis 2005) and thus may not make educated decisions even when the information is provided (Braunsberger, Lucas, and Roach 2005). Day (1976) identified the objectives of information disclosures as "enhancing the consumer's right to know, improving the quality of products and competition, facilitating value comparisons, enabling buyers to better match products and needs and thus increasing purchase satisfaction, and pursuing broad educational aims such as creating general public interest in nutrition or sensitivity to energy conservation" (42). In the case of death care products, one of the explicit purposes of the GPL is to assert the consumer's right to know about alternatives. The impact of the provision of pricing and other information, however, has not been gauged, either in terms of its effect on competition or in terms of its value to consumers.
Purchasing Contexts
There are two primary contexts in which a consumer would normally purchase end of life products or services: at-need and preneed. Consumers tend to resist or avoid making decisions for their own funerals (Wirthlin Group 2005), which then may create either an emergency purchase when they are dying or a situation where a grieving loved one must make the decisions. As noted earlier, time pressure and emotional duress are assumed to be strong influences during at-need decision making. Grief may restrict a person's awareness of whether he or she is being incorrectly charged, or it may limit his or her ability and desire to share information if such practices are experienced. Either of these situations may result in a consumer who is not price sensitive, who is not aware of alternatives, or who may be less aware of the protections afforded by laws (Gentry et al. 1995).
It would follow that given the financial outlay involved in purchasing death care products (Fan and Zick 2004), consumers would engage in more preplanning rather than oblige someone else to make purchase decisions for them (after their demise). Limited direct evidence, however, suggests that consumers have the tendency to ignore or otherwise avoid the consideration of purchasing products associated with death (Kopp and Pullen 2002). A national survey conducted in 2004 reported that 72% of consumers believed prearranging for a funeral to be a good idea, but less than 36% of those consumers had actually done so (Wirthlin Group 2005).
Although taking steps to plan a funeral can be as simple as discussing plans and leaving instructions with family about end of life arrangements--actions that do not involve money--most avoid thinking about or taking even these steps. As a policy alternative, a social marketing approach (Andreasen 1993) would be appropriate to help develop and implement segmentation and targeting strategies to encourage planning behavior. Since individuals are cognizant of the benefits of planning for end of life but many fail to engage in planning activity, learning more about the factors that finally induce action, whether it is reaching a certain age, starting a family, or experiencing the death of a loved one might be helpful in advancing concrete policy actions.
Information Search and Evaluation of Alternatives
Most consumer purchases are a result of nominal or limited decision making and thus involve limited information search immediately prior to purchase (Dickson and Sawyer 1990). Even for major purchases, information search tends to be limited, with the greatest percentage of consumers performing little information search prior to purchase (Urbany, Dickson, and Wilkie 1989; Westbrook and Fornell 1979). Gentry et al. (1995) suggested that when faced with the responsibility of preparing the funeral arrangements for a loved one, grief may render an individual vulnerable and unable to perform the role traditionally expected of a consumer in the market economy. For funeral products and services, an individual's opportunity or propensity to engage in search behavior may be reduced even further by situational factors such as time, health, knowledge of alternatives, or financial resources; in an at-need situation, these factors may not work in the consumer's favor. So, what is generally considered information search by consumers may be further curtailed.
Bundling is a common product strategy used by many manufacturers, retailers, and service providers to differentiate their products and services from competitors. However, bundling or tying was presumed to be a means by which funeral providers could rationalize or disguise costs to consumers or could compel consumers to purchase unwanted items. The debundling element of the Funeral Rule was thus intended to increase competition and seemingly increase consumer choice; it has encouraged the emergence of third-party, nonfuneral home suppliers. For example, warehouse-style retailer Costco recently began piloting the sale of discounted caskets at its retail outlets at a fraction of the cost a consumer would pay at a funeral home (Stiff competition 2004). Internet sites offering caskets, vaults, urns, and other funeral merchandise directly to consumers are now common. Although the rapidly increasing third-party segment of the industry may provide less expensive alternatives to consumers, the availability of more alternatives may not benefit the at-need consumer when he/she may not be rational.
In general, even when bundles have only a few items, the amount of information available for "rational" decision making can be substantial, to the point where consumers may look for ways to simplify the evaluation task (Harris and Blair 2006; Yadav and Monroe 1993). Incorporating all available information into the evaluation of a bundle (e.g., when making an expensive purchase) can be an overwhelming processing task. In this situation, consumers may apply a simplifying heuristic that enables them to approach the evaluation task as a series of smaller or easier evaluations. So in an at-need situation, bundling may actually help consumers. However, this is further reason to encourage preplanning in this product category, since purchasing individual funeral products or services may be less difficult as well as less costly for consumers, the decreased potential for deception notwithstanding.
Judgment and Decision Making
As discussed earlier, consumers in an at-need end-of-life purchase situation may spend little time evaluating alternatives or making purchase decisions. Additionally, consumers who are overwrought may make purchasing decisions that are based primarily on emotion. Consumer research suggests that under emotional circumstances, individuals may engage in less effortful processing (Eagly and Chaiken 1993). Other behavioral theories would support the argument that certain negative emotions reduce an individual's cognitive capacity and affect decision-making abilities (Baumeister 2002; Fredrickson 1998). These are all consistent with the assumptions that motivate death care regulation.
The Funeral Rule also has among its primary goals the provision of price information for death care products and services. Early studies examining consumer attitudes toward funeral homes have suggested that there are nonprice factors that may influence a consumer's choice of a funeral home (FTC 1982; Marks and Calder 1982). For example, previous experience with the funeral home, knowing the funeral director, the location of the funeral home, and the reputation of the funeral home were all identified as among consumers' evaluative criteria. What is not known is whether consumers exhibit price sensitivity in choosing retailers or in purchasing death care products or how much effort consumers are willing to expend in order to save money in either preneed or at-need circumstances. Further, the usefulness of providing objective price information when consumers may be more influenced by emotion is unclear.
Consumer Complaints and Postpurchase Evaluation
One of the measures of the efficacy of the regulation of the death care industry has been consumer complaints (GAO 1999). Very few complaints are filed with the state regulatory agencies that oversee the death care industry (GAO 2003), although nonprofit organizations report higher numbers (FAMSA 1999). Simmons (1975) suggested that individuals that have experienced the death of a love one avoid postpurchase evaluation of funerals in an attempt to avoid unpleasant memories. With this in mind, does the fact that there are fewer complaints filed with regulatory agencies mean that consumers are satisfied with their purchase experiences, or are they just less likely to complain?
Dissatisfaction with a product or service is the primary driver of complaints (McAlister and Erffmeyer 2003). Generally, consumer research would suggest that the number of consumers who take a concern to a government agency or consumer protection group is relatively small (Tipper 1997). If consumers believe that remedy is possible by complaining directly to the selling organization, they are less likely to voice complaints to others (Singh and Wilkes 1996). Subsequently, in the case of funerary transactions, consumers may be complaining directly to the funeral provider instead of filing complaints with state and regulatory agencies.
Additionally, consumer research has provided evidence of a negative relationship between knowledge, or familiarity with a product, and satisfaction (Soderlund 2002). Limited direct evidence suggests that consumers are generally unaware of what the Funeral Rule requires of funeral retailers (AARP 2000; Kemp and Kopp 2006). Further, if responsibilities for handling consumer complaints shift between or are divided among agencies at the state level, consumers may not know to whom to contest unfair treatment. Therefore, the lack of consumer complaints with state and regulatory agencies may not be an adequate barometer for assessing regulatory efficacy and consumer satisfaction. Ascertaining the dynamics of postpurchase evaluation for this product category is needed to gain further insight into regulatory effectiveness and compliance.
As discussed earlier, consumers in an at-need end-of-life purchase situation may spend little time evaluating alternatives or making purchase decisions. Additionally, consumers who are overwrought may make purchasing decisions that are based primarily on emotion. Consumer research suggests that under emotional circumstances, individuals may engage in less effortful processing (Eagly and Chaiken 1993). Other behavioral theories would support the argument that certain negative emotions reduce an individual's cognitive capacity and affect decision-making abilities (Baumeister 2002; Fredrickson 1998). These are all consistent with the assumptions that motivate death care regulation.
The Funeral Rule also has among its primary goals the provision of price information for death care products and services. Early studies examining consumer attitudes toward funeral homes have suggested that there are nonprice factors that may influence a consumer's choice of a funeral home (FTC 1982; Marks and Calder 1982). For example, previous experience with the funeral home, knowing the funeral director, the location of the funeral home, and the reputation of the funeral home were all identified as among consumers' evaluative criteria. What is not known is whether consumers exhibit price sensitivity in choosing retailers or in purchasing death care products or how much effort consumers are willing to expend in order to save money in either preneed or at-need circumstances. Further, the usefulness of providing objective price information when consumers may be more influenced by emotion is unclear.
Consumer Complaints and Postpurchase Evaluation
One of the measures of the efficacy of the regulation of the death care industry has been consumer complaints (GAO 1999). Very few complaints are filed with the state regulatory agencies that oversee the death care industry (GAO 2003), although nonprofit organizations report higher numbers (FAMSA 1999). Simmons (1975) suggested that individuals that have experienced the death of a love one avoid postpurchase evaluation of funerals in an attempt to avoid unpleasant memories. With this in mind, does the fact that there are fewer complaints filed with regulatory agencies mean that consumers are satisfied with their purchase experiences, or are they just less likely to complain?
Dissatisfaction with a product or service is the primary driver of complaints (McAlister and Erffmeyer 2003). Generally, consumer research would suggest that the number of consumers who take a concern to a government agency or consumer protection group is relatively small (Tipper 1997). If consumers believe that remedy is possible by complaining directly to the selling organization, they are less likely to voice complaints to others (Singh and Wilkes 1996). Subsequently, in the case of funerary transactions, consumers may be complaining directly to the funeral provider instead of filing complaints with state and regulatory agencies.
Additionally, consumer research has provided evidence of a negative relationship between knowledge, or familiarity with a product, and satisfaction (Soderlund 2002). Limited direct evidence suggests that consumers are generally unaware of what the Funeral Rule requires of funeral retailers (AARP 2000; Kemp and Kopp 2006). Further, if responsibilities for handling consumer complaints shift between or are divided among agencies at the state level, consumers may not know to whom to contest unfair treatment. Therefore, the lack of consumer complaints with state and regulatory agencies may not be an adequate barometer for assessing regulatory efficacy and consumer satisfaction. Ascertaining the dynamics of postpurchase evaluation for this product category is needed to gain further insight into regulatory effectiveness and compliance.
SUMMARY AND CONCLUSIONS
For over a century, the death care industry has been subject to inconsistent and varying degrees of regulation. Arising from complaints by consumers and consumer activist groups, the FTC intervened and promulgated regulation with intentions to protect the consumer. However, the efficacy of this intervention is still inconclusive.
Americans are essentially uncomfortable with the topic of death itself (Becker 1973). Given the financial expense and cultural importance of the rites of death, it would seem logical that Americans would prepare for funerals as they prepare for weddings. Such is not the case, of course.
A minority of Americans have engaged in preplanning of funerals, although a majority says it is important to do so. It would seem that the best form of consumer protection would be for death care buyers to make decisions before the products and services are needed. However, consumers are reluctant to do so or resist, creating a situation that increases the potential for their own exploitation.
Regulation in the funeral industry is thus intended to protect the bereaved buyer who is faced with having to make death care purchase decisions under difficult circumstances: lack of prior information, time pressure, and a vulnerable, extremely emotional state. Because there have been few changes to federal consumer protection laws, it should not be inferred that this is a static issue. Few political leaders aspire to establish a legacy on issues of death care reform. What has become apparent is that federal regulation is relatively narrow in its scope--only applying to the funeral home segment of the death care industry--and there are numerous disparities at the state level that leave consumers vulnerable.
What appears most likely is that modifications in the current regulation will be forthcoming as new developments take place in the industry and the needs of consumers change. Several factors will make this necessary: (1) changes in demographics related to an increase in the total number of "consumers" of death care products and services; (2) changes in consumer preferences, including an apparent desire for increased alternatives and for the reduction of costs of those products and services; (3) availability of new retailers or other distributors, including third-party suppliers, which may or may not be Internet based; (4) the repartitioning of "death care industry" segments, such that cemeteries or other entities are beginning to provide the goods and services once specific to funeral homes, and (5) the proliferation of services that are relatively unregulated, including preneed contracts. All of these factors have created the necessity of redefining the industry and its regulation.
In the seminal discussions thirty years ago that led to the Funeral Rule, it was noted that "[w]hat is missing is objective research which would be helpful to state as well as federal authorities and to industry representatives and practitioners themselves" (FTC 1977, 131). With few exceptions, this has not changed. For some of the components of federal and state regulation of industry practices, consumer theory would support underlying assumptions. Other regulatory elements, however, do not appear to be consistent with what we know about consumers. Systematic research would help to gain a better understanding of not only consumer decision making but also to guide regulation in this unique product category.
For over a century, the death care industry has been subject to inconsistent and varying degrees of regulation. Arising from complaints by consumers and consumer activist groups, the FTC intervened and promulgated regulation with intentions to protect the consumer. However, the efficacy of this intervention is still inconclusive.
Americans are essentially uncomfortable with the topic of death itself (Becker 1973). Given the financial expense and cultural importance of the rites of death, it would seem logical that Americans would prepare for funerals as they prepare for weddings. Such is not the case, of course.
A minority of Americans have engaged in preplanning of funerals, although a majority says it is important to do so. It would seem that the best form of consumer protection would be for death care buyers to make decisions before the products and services are needed. However, consumers are reluctant to do so or resist, creating a situation that increases the potential for their own exploitation.
Regulation in the funeral industry is thus intended to protect the bereaved buyer who is faced with having to make death care purchase decisions under difficult circumstances: lack of prior information, time pressure, and a vulnerable, extremely emotional state. Because there have been few changes to federal consumer protection laws, it should not be inferred that this is a static issue. Few political leaders aspire to establish a legacy on issues of death care reform. What has become apparent is that federal regulation is relatively narrow in its scope--only applying to the funeral home segment of the death care industry--and there are numerous disparities at the state level that leave consumers vulnerable.
What appears most likely is that modifications in the current regulation will be forthcoming as new developments take place in the industry and the needs of consumers change. Several factors will make this necessary: (1) changes in demographics related to an increase in the total number of "consumers" of death care products and services; (2) changes in consumer preferences, including an apparent desire for increased alternatives and for the reduction of costs of those products and services; (3) availability of new retailers or other distributors, including third-party suppliers, which may or may not be Internet based; (4) the repartitioning of "death care industry" segments, such that cemeteries or other entities are beginning to provide the goods and services once specific to funeral homes, and (5) the proliferation of services that are relatively unregulated, including preneed contracts. All of these factors have created the necessity of redefining the industry and its regulation.
In the seminal discussions thirty years ago that led to the Funeral Rule, it was noted that "[w]hat is missing is objective research which would be helpful to state as well as federal authorities and to industry representatives and practitioners themselves" (FTC 1977, 131). With few exceptions, this has not changed. For some of the components of federal and state regulation of industry practices, consumer theory would support underlying assumptions. Other regulatory elements, however, do not appear to be consistent with what we know about consumers. Systematic research would help to gain a better understanding of not only consumer decision making but also to guide regulation in this unique product category.
APPENDIX 1
Itemization of Prices Required by the Funeral Rule
* Forwarding of remains to another funeral home
* Receiving remains from another funeral home
* Transfer of remains to the funeral home
* Direct cremation
* Immediate burial
* Embalming
* Other preparation of the body
* Hearse/limousine
* Use of facility and staff for viewing
* Use of facility and staff for funeral ceremony
* Use of facility and staff for memorial service
* Use of equipment and staff for graveside ceremony
* Individual casket prices or their price range
* Individual outer burial container prices or their range
* Basic services of funeral director and staff, and overhead
Itemization of Prices Required by the Funeral Rule
* Forwarding of remains to another funeral home
* Receiving remains from another funeral home
* Transfer of remains to the funeral home
* Direct cremation
* Immediate burial
* Embalming
* Other preparation of the body
* Hearse/limousine
* Use of facility and staff for viewing
* Use of facility and staff for funeral ceremony
* Use of facility and staff for memorial service
* Use of equipment and staff for graveside ceremony
* Individual casket prices or their price range
* Individual outer burial container prices or their range
* Basic services of funeral director and staff, and overhead
REFERENCES
AARP. 1995. A Summary of State Statue: Pre-need Funeral and Burial Agreements. Washington, DC: AARP.
--. 1999. Older Americans and Pre-need Funeral and Burial Arrangements: Findings from a 1998 National Telephone Survey. Washington, DC: AARP.
--. 2000. Public Awareness of the Funeral Rule: Findings from an AARP Survey. Washington, DC: AARP.
--. 2004. Funeral Arrangements and Memorial Services. http://www.aarp.org/families/grief_loss/a2004-11-15-arrangements.html.
Andreasen, Alan. 1993. Presidential Address: A Social Marketing Research Agenda for Consumer Behavior Researchers. In Advances in Consumer Research, edited by Michael Rothschild and Leigh McAlister (1-5). Provo, UT: Association for Consumer Research.
Arizona House of Representatives. 2004. Minutes, Committee on Health. 46th Legislature, 2nd Session. February 26.
Baumeister, Roy F. 2002. Yielding to Temptation: Self-control Failure, Impulsive Purchasing and Consumer Behavior. Journal of Consumer Research, 28 (4): 670-676.
Becker, Ernest. 1973. The Denial of Death. New York: Free Press.
Bowman, Leroy. 1959. The American Funeral: A Study in Guilt, Extravagance and Sublimity. Washington, DC: Public Affairs Press.
Braunsberger, Karin, A. Laurie Lucas, and Dave Roach. 2005. Evaluating the Efficacy of Credit Card Regulation. International Journal of Bank Marketing, 23 (3): 237-254.
Caplovitz, David. 1967. The Poor Pay More. Glencoe, IL: Free Press.
Carlson, Lisa. 1998. Caring for the Death: Your Final Act of Love. Hinesburg, VT: Upper Access.
--. 1999. Comments of the Funeral and Memorial Societies of America on the Commission's Review of the Funeral Rule. FAMSA--Funeral Consumers Alliance, Inc. Comment A-76.
Carson, Rachel. 1962. Silent Spring. New York: Houghton Mifflin.
Casket & Funeral Supply Association. 2005. About the Casket Industry. http://www.cfsaa.org/about.php.
Casket Royale, Inc. v. Mississippi. 2000. 124 F. Supp. 2d 434. U.S. District Court, Southern District of Mississippi, Jackson (October 31).
Cochrane, Don S. 2002. Simply Essential Funeral Planning. Bellingham, WA: International Self-Counsel.
Couch, Mark P. 2006. Mortuary Oversight Sought Bill would Create Regulatory Program Amid Claims of Abuse. Denver Post, March 7: B-01.
Craigmiles v. Giles. 2000. 2000 U.S. Dist. LEXIS 22435. U.S. District Court, Eastern District of Tennessee (July 18).
--. 2002. 312 F. Supp. 3d 220. U.S. Court of Appeals, Sixth Circuit (December 6).
The Yoga Therapist Will See You Now.
FOR three years after a car crash left her with chronic pain, Deanna Adams searched high and low for relief. Mrs. Adams, 41, a stay-at-home mother in West Palm Beach, Fla., consulted a physical therapist, a chiropractor, two doctors (a pain specialist and a neurologist) and an acupuncturist -- to no avail.
She also went to basic yoga, hoping asanas would ease the debilitating back pain, neck spasms and migraines that plagued her. After each class at LA Fitness, Mrs. Adams felt better for a few hours, but her symptoms inevitably returned.
It was only after her first yoga therapy session with Emily Large, who runs Living Large Therapeutics, that she realized why group yoga left her cold. ''When you go to a yoga class, everybody is doing the same thing,'' Mrs. Adams said. ''If you have a neck or back injury, the instructor doesn't know.''
Yoga therapy -- one-on-one visits which take place in medical clinics, physical therapist offices and yoga studios -- takes into account pain and injuries for a customized experience.
As her client did yoga postures she had handpicked, Mrs. Large, a yoga therapist with a physical therapy license, lightly touched her to sense where Mrs. Adams was tense or weak. Then she designed a sequence of poses to target those areas, including a lying twist with the knees bent and a repetitive variation of triangle pose. As Mrs. Adams grew stronger and more flexible doing poses at home, her routine was updated, and after three months, her pain has largely subsided.
People often turn to yoga when they are injured because they want gentle exercise that's easy on the joints. But, most yoga teachers don't have time to address individual problems, nor do they regularly deal with special needs.
Enter yoga therapy, an emerging field in the United States, although commonplace in India. Therapists work in small groups or privately, adapting poses for musculoskeletal problems that have been diagnosed by doctors. Other therapists help people deal with the anxiety of living with illnesses as varied as cancer and chronic fatigue.
'We recognize that not every pose is for everybody,'' said Robin Rothenberg, a yoga therapist who runs the Yoga Barn studios outside of Seattle. ''If you are a 20-something dancer, that is one thing and if you are a 50-year-old computer programmer, that's a different thing.''
Yoga therapy is nowhere near as popular as one-pose-fits-all classes. Still, in the last three years, membership in the International Association of Yoga Therapists, a trade group based in Prescott, Ariz., has almost tripled to 2,060, from 760.
But experts inside and outside the industry say yoga therapy should be approached with caution. In general, a person can practice as a yoga therapist after 200 hours of yoga teacher training, which might include basic training in anatomy, breathing, meditation and giving adjustments.
''Anybody can hang their shingle and say they are a yoga therapist,'' said Julie Gudmestad, a physical therapist who also practices yoga therapy in Portland, Ore. ''Buyer beware. I've seen some strange things done in the name of yoga therapy.''
Most reputable yoga therapists have additional credentials. Some are physical therapists or nurses or have completed two years of training in Iyengar yoga, which emphasizes anatomy and kinesiology.
Others have been certified as therapists by schools like Integrative Yoga Therapy or American Viniyoga Institute. The institute is run by Gary Kraftsow; applicants must have completed 500 hours of his teacher training. His course teaches the clinical applications of yoga for spine, joint and muscle problems.
There is no national credentialing system, and the lack of industry-wide standards worries doctors. ''You need some core set of certification that allows a patient to know that they are going to someone from whom they can reliably get appropriate treatment,'' Dr. James Weinstein, chairman of the department of orthopedic surgery at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the editor of the medical journal Spine. ''I have certainly seen patients asked to do positions that have made them worse.''
Just as certain conditions can be helped by extension, flexion, twisting or side bending, they can also be aggravated, said Robert Forster, a physical therapist in Santa Monica, Calif.
Some doctors advocate its use, however. ''I deeply believe in yoga and know the therapeutic value of yoga for health care,'' said Dr. Michael Sinel, an assistant professor of physical medicine and rehabilitation at the University of California, Los Angeles, who has a private practice in Santa Monica. In the next six months, he plans to start YogaMed, a company that will offer medical care and therapeutic yoga within the Yoga Works chain of studios.
There is some evidence that certain yoga poses help alleviate chronic back pain. A randomized, controlled study published in the Annals of Internal Medicine in 2005 found that participants who followed a pose sequence designed by a yoga therapist improved function more than those given a self-care book or sent to exercise class. (The 101 participants did not include patients with sciatica, previous back surgery or pregnant women.) Now, the National Institutes of Health has allocated $1.2 million for a second study to see, in part, if the results can be replicated on a larger scale.
Yoga therapists are not qualified to diagnose injuries, although some do, said Leslie Bogart, a yoga therapist in Santa Monica, who has worked as a nurse. ''Everybody should be seen by a medical person first, without question,'' Ms. Bogart said. ''Yoga should be an adjunct to'' treatment, not ''a replacement.''
A handful of doctor's offices already offer therapeutic yoga. Dr. Loren Fishman, who runs a physical medicine and rehabilitation practice in Manhattan, studied Iyengar yoga in India before medical school, and now recommends poses to patients like Sharon Williams.
Ms. Williams, 46, a development director at Dance Theater of Harlem, suffered from chronic shoulder pain. An M.R.I. revealed a torn rotator cuff, for which Dr. Fishman prescribed, among other things, a variation of a headstand using a chair. This pose can help relieve pain and restore range of motion, yoga therapists say, because of a method called muscular substitution -- training the body to avoid aggravating an existing problem by using other muscles.
This is plausible, said Dr. J. Hearst Welborn, an orthopedic surgeon in San Pablo, Calif. He added that actively trying to recover helps: ''Mind over matter has a huge effect on people's pain.''
Longtime yoga therapists say the next step for them is learning to work with doctors. Larry Payne, who has practiced since 1982 and is the founding president of the yoga therapist association, said therapists need to learn to read medical reports and to work in clinical settings. ''The doctors aren't interested in Sanskrit, they just want to be sure that yoga therapists they work with are properly trained,'' he said.
To that end, Dr. Payne created a yoga therapy teacher training course at Loyola Marymount University in Los Angeles, where students learn yoga therapy for both systemic and muscular ailments.
Dr. Payne and Dr. Richard P. Usatine also started yoga classes for medical students at the David Geffen School of Medicine at U.C.L.A. ''Once they understand and can feel the value of yoga personally, they can then suggest and prescribe it for their patients,'' said Dr. Usatine, a professor of family medicine at the University of Texas Health Science Center at San Antonio.
Nationwide, yoga is provided at 93 percent of 755 integrative medical centers, facilities offering under one roof both traditional medicine and other approaches to health and wellness. But it's unclear how many offer yoga therapy, said Cary Wing, the executive director of the Medical Fitness Association, a nonprofit group.
DEPRESSION
There are two types of depression. One type starts when a tragic event happens, usually with death or a separation, and the other type of depression appears suddenly and seems not to have any particular reason for manifesting.
In the first case, the solution is a philosophical comprehension of the meaning of life and the meaning of death; this helps depressed people accept their suffering without revolt. If this is your situation, I recommend you read my ebook Wisdom that was written specially in order to give support to people that are suffering constantly for any reason. You can find it on my website. The tragic loss of someone we love, especially if this person is young, is something we don’t every really overcome. The depression we feel seems unbearable – it seems we have no hope of finding relief! However, time will pass, and without understanding how, we always do overcome it, even though the sadness won’t disappear completely from our life.
But sometimes, this depression becomes worse instead of being slowly cured by time, and then we face despair. If things are this way for you, you certainly need more help. I’ve almost finished my ebook about dream decoding that is sure to help you immensely, but for the time being, I’ll help as much as I can through my articles in this ezine.
You have to have in mind that the human being is wild, and he can’t understand how far he actually is from psychical health. He has only a tiny human conscience which he knows only partially. Even this is mainly absurd, since it is based in his Ego and therefore, selfish. If he suffers a lot on this planet, it is because he is too absurd. He provokes his own suffering, and he destroys his personality instead of developing it. He makes only mistakes during his life, one after the other. He doesn’t learn anything from them, though, and so he doesn’t become better.
You have to understand that your suffering now is not something without any meaning that is only eroding you. You have to develop all your psychological functions, and become very sensitive in order to have psychical health. This process can only be completed through suffering. Sometimes we need to suffer more in order to learn more and to be transformed. What is happening to you now is not something without meaning, that could (or even should) be avoided.
You have to overcome your depression by accepting this suffering like a hero. This is the only way you can transform your nature and become a wise and balanced person that can help others overcome their problems too.
If your depression is unexplainable, then you more than anyone else, need psychotherapy through dream interpretation! This is the only safe and guaranteed way you have to be able to discover the real reason for your depression, since the unconscious that produces your dreams knows everything about you and your life.
I’ll try to give you some information about dream interpretation in my next articles, even though this can really be done properly only through a book or ebook - you’ll have to return to my past lessons several times, before proceeding. These articles are not chapters of a book; they each have a defined end. I can’t expect you to keep all of them and make a collection with my articles though, so that you can have an ebook about depression and how we can cure it. I don’t even know if you are a regular reader or if you are reading this ezine and one of my articles for the first time. So, I can’t explain too much this way. I can only give you short lessons, but they can still be very helpful if you take my advice seriously. I’ve helped many people overcome serious psychical diseases and serious existential problems.
I know that your depression is very serious, no matter whether it was provoked by a tragic event, or you don’t really know its origin. Of course it can’t be compared with the common sadness that we often hide from others, so that people won’t worry about us, we won’t have to give them embarrassing explanations that upset us, etc. But you have to behave as if your very serious and unbearable depression is only a common sadness that you have to hide from other people, mainly in order to make them feel better near you. You don’t want to be a burden for everyone because you are weak. Do you?
This way you’ll discipline yourself to acquire the resistance you need in order to completely overcome your depression eventually! So, stop complaining, hide the fact you only want to stay in a corner crying, and start pretending you are strong. The more you can show this attitude, the more you’ll really overcome the inner feelings of depression.
If however you feel you absolutely cannot do it, don’t insist. Perhaps your psychical condition won’t let you help yourself. You may need more help from outside. Ask for more help - tell everyone that you are desperate. Go to a psychologist, look for a person that is spiritual and can illuminate you, do something! Don’t just stay in this condition, without any action. Define your psychical illness and start curing your soul: either be a hero and start behaving as if you didn’t have any special problem, or accept that you need to be helped as a patient and follow exactly your doctor’s instructions, with devotion. You are going to reach psychical health, one way or the other. Everything depends on your attitude!
Beauty Tips You Have Never Heard
Your morning beauty regime takes you exactly 12 minutes. First comes the face wash, then the astringent, followed by the moisturizer. And the list goes on. It’s become such a chore, but wasn’t there a time when this routine was fun? Well, we decided to take you back to the days when applying makeup was a treat by giving you some innovative beauty tips and tricks to spice up your routine.
To get this insider information, we contacted Carmindy, resident make-up artist on TLC’s “What Not to Wear,” and author of The 5 Minute Face. Here are her 10 beauty tips to leave you feeling fresh and fabulous.
Beauty Tip # 1 - Make perfume last. A few spritzes of perfume in the morning will not carry you through the day, no matter how expensive your bottle may be. To make your scent last, try this beauty tip: put an unscented moisturizer on first and then spray on your perfume a few seconds later. “There’s so much alcohol in perfume,” Carmindy explains, “that if you spray it on dry skin, a lot of times it evaporates so quickly. But if you have moisturizer on your skin it adheres much better.”
Beauty Tip # 2 - Lip gloss without the goop. Instead of directly putting the tube of gloss to your lips, Carmindy recommends adding an extra step to ensure less stickiness. “I like to put lip gloss on my fingertips first and then just pat it onto the flesh of my lips. And this way you’ll get a little bit of glow, but it won’t be too goopy.” Also, try a moisturizing lipstick or a lip stain first before you add the gloss to make sure the color stays put.
Beauty Tip # 3 - A sweet scrub. “The best exfoliate in the world is regular white table sugar.” If every scrub out there contains some form of sugar, like “Almond Sugar Scrub” or “Brown Sugar Scrub,” why not just use what’s in your kitchen cupboard? “What happens is that the small crystals dissipate in water so they don’t tear your skin.” And, if you have sensitive skin, don’t fret. “It even works better because with other products you might not like a fragrance or a lot of ingredients,” states Carmindy. When you’re in the shower, all you have to do is lather your face up like normal and then get a handful of sugar and scrub your face. And if you run out you’ll be able to ask your cute neighbor for a spot of sugar!
Beauty Tip # 4 Ditch your spot concealer. Instead of fumbling around your makeup bag for multiple concealers in the morning, just stick to one, advises Carmindy. The reason why? Because you can actually use the foundation stuck to the top of the cap of your liquid all-over concealer as your spot-treatment. “It oxidizes there so it becomes a little bit thicker.” Plus, she says, “It’s the same shade as your foundation, so it will instantly erase your blemish.” To apply, just take a small tip concealer brush and dip into the cap of your foundation, or the nozzle if you use a spray. Then brush it on the spots and you’re ready to go. Now it will be a good thing when your foundation lid gets cakey.
Beauty Tip # 5 - Recycle: Good for the earth, good for your lips. What are you supposed to do when your four best lipsticks are almost gone and your finger is tired from scraping out the remnants below? Carmindy suggests combining the half-used sticks into your own lip pallet. “Go to the drug store and purchase a plastic pill box and dig out the lipstick that’s left in the tubes. Then put each color into a different little section of the pill box.” You can mix and match the colors or even put Vaseline in one of the sections to make your own lip gloss.
Beauty Tip # 6 Celebrity-size lips. To get fuller lips people often outline them with a pencil, but most of the time it looks noticeable and unsophisticated (especially when the lipstick comes off and you’re left with just that awful line). To get invisible enhancement, Carmindy recommends you take a Q-tip and dip it in a little bit of white shimmer eye shadow and lightly trace the outside of your lips. “What will happen is that the shimmer will capture the light and make your lips seem larger.” You won’t be able to see it, but the slight glimmer will do the trick. Great if you don’t have any collagen handy.
Beauty Tip # 7 - Bronzed but not dirty. Dusting bronzer all over your face can make you look like you’ve been rolling around in the sand box all day or have picked up a part time job as a chimney sweep. Carmindy prefers a spray bronzer to get the appearance of a fresh summer tan. “I like to spray a sponge and then what I do is just push it onto the skin—on the temples and then right underneath the cheekbones because this is kind of where the sun would kiss your face. And if you like powder bronzer you can apply it in the same places too.”
Beauty Tip # 8 - Brow breakthrough. If you’ve been awarded barely there eyebrow DNA, you’ve probably tried everything to make them visible—and figured out that most of the time these products end up rubbing off by the end of the day. If you still want eyebrows at five p.m., Carmindy advises buying waterproof liquid eyeliner that matches your hair color like black, brown or taupe. Then, she says, “You can take an angled brush and feather the liquid eyeliner on to your eyebrows and it will stay put all day long. It looks more natural than a pencil and stays longer.” It’s a win-win.
Now if you’re like me and are on the opposite end of the brow spectrum you might need some help keeping your out-of-control brows in check. To do this, “Take a spooly brush or an old tooth brush, put a little hair gel on there and just brush it onto your eyebrows to have them stay put.”
Beauty Tip # 9 - Not your average smoky eye. “What I like to do is take a color like a navy blue or a sparkling kind of burgundy purple and just line the inside rim and right along the upper and lower lash line and then smudge it with a Q-tip. That way, there’s no eye shadow pushing the eye back, but you still have the smoky effect because they’re lined with color. If you have deep-set eyes, Carmindy advises you to avoid putting dark shadow on your eyelids because it will make them seem even more pushed back. “There are so many ways to do a smoky eye, but people always think there’s only one way to do it.”
Beauty Tip # 10 - Save time and eye shadowRunning late in the morning? The best thing you can put on is white shimmering highlight powder. “If you highlight three key places you set of the planes of your face—you don’t even need eye shadow,” says Carmindy. These key spots are underneath the eyebrow, on the inside corner of the eye and on top of the cheekbone. “It brings sparkle to the eye; it lifts up the lid and draws attention to the top of the cheekbone.” Now all you need is a big cup of coffee to actually feel as awake as you look.
Who says your beauty routine has to be boring—especially now that you can take a box of sugar with you in the shower or turn a pill box into a personalized lip pallet. With these beauty tips You just might have to rethink your 12 minute routine after all.
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Beautiful
Barbara Harrington discloses some of her best make up tips when it comes to eye brow
AARP. 1995. A Summary of State Statue: Pre-need Funeral and Burial Agreements. Washington, DC: AARP.
--. 1999. Older Americans and Pre-need Funeral and Burial Arrangements: Findings from a 1998 National Telephone Survey. Washington, DC: AARP.
--. 2000. Public Awareness of the Funeral Rule: Findings from an AARP Survey. Washington, DC: AARP.
--. 2004. Funeral Arrangements and Memorial Services. http://www.aarp.org/families/grief_loss/a2004-11-15-arrangements.html.
Andreasen, Alan. 1993. Presidential Address: A Social Marketing Research Agenda for Consumer Behavior Researchers. In Advances in Consumer Research, edited by Michael Rothschild and Leigh McAlister (1-5). Provo, UT: Association for Consumer Research.
Arizona House of Representatives. 2004. Minutes, Committee on Health. 46th Legislature, 2nd Session. February 26.
Baumeister, Roy F. 2002. Yielding to Temptation: Self-control Failure, Impulsive Purchasing and Consumer Behavior. Journal of Consumer Research, 28 (4): 670-676.
Becker, Ernest. 1973. The Denial of Death. New York: Free Press.
Bowman, Leroy. 1959. The American Funeral: A Study in Guilt, Extravagance and Sublimity. Washington, DC: Public Affairs Press.
Braunsberger, Karin, A. Laurie Lucas, and Dave Roach. 2005. Evaluating the Efficacy of Credit Card Regulation. International Journal of Bank Marketing, 23 (3): 237-254.
Caplovitz, David. 1967. The Poor Pay More. Glencoe, IL: Free Press.
Carlson, Lisa. 1998. Caring for the Death: Your Final Act of Love. Hinesburg, VT: Upper Access.
--. 1999. Comments of the Funeral and Memorial Societies of America on the Commission's Review of the Funeral Rule. FAMSA--Funeral Consumers Alliance, Inc. Comment A-76.
Carson, Rachel. 1962. Silent Spring. New York: Houghton Mifflin.
Casket & Funeral Supply Association. 2005. About the Casket Industry. http://www.cfsaa.org/about.php.
Casket Royale, Inc. v. Mississippi. 2000. 124 F. Supp. 2d 434. U.S. District Court, Southern District of Mississippi, Jackson (October 31).
Cochrane, Don S. 2002. Simply Essential Funeral Planning. Bellingham, WA: International Self-Counsel.
Couch, Mark P. 2006. Mortuary Oversight Sought Bill would Create Regulatory Program Amid Claims of Abuse. Denver Post, March 7: B-01.
Craigmiles v. Giles. 2000. 2000 U.S. Dist. LEXIS 22435. U.S. District Court, Eastern District of Tennessee (July 18).
--. 2002. 312 F. Supp. 3d 220. U.S. Court of Appeals, Sixth Circuit (December 6).
The Yoga Therapist Will See You Now.
FOR three years after a car crash left her with chronic pain, Deanna Adams searched high and low for relief. Mrs. Adams, 41, a stay-at-home mother in West Palm Beach, Fla., consulted a physical therapist, a chiropractor, two doctors (a pain specialist and a neurologist) and an acupuncturist -- to no avail.
She also went to basic yoga, hoping asanas would ease the debilitating back pain, neck spasms and migraines that plagued her. After each class at LA Fitness, Mrs. Adams felt better for a few hours, but her symptoms inevitably returned.
It was only after her first yoga therapy session with Emily Large, who runs Living Large Therapeutics, that she realized why group yoga left her cold. ''When you go to a yoga class, everybody is doing the same thing,'' Mrs. Adams said. ''If you have a neck or back injury, the instructor doesn't know.''
Yoga therapy -- one-on-one visits which take place in medical clinics, physical therapist offices and yoga studios -- takes into account pain and injuries for a customized experience.
As her client did yoga postures she had handpicked, Mrs. Large, a yoga therapist with a physical therapy license, lightly touched her to sense where Mrs. Adams was tense or weak. Then she designed a sequence of poses to target those areas, including a lying twist with the knees bent and a repetitive variation of triangle pose. As Mrs. Adams grew stronger and more flexible doing poses at home, her routine was updated, and after three months, her pain has largely subsided.
People often turn to yoga when they are injured because they want gentle exercise that's easy on the joints. But, most yoga teachers don't have time to address individual problems, nor do they regularly deal with special needs.
Enter yoga therapy, an emerging field in the United States, although commonplace in India. Therapists work in small groups or privately, adapting poses for musculoskeletal problems that have been diagnosed by doctors. Other therapists help people deal with the anxiety of living with illnesses as varied as cancer and chronic fatigue.
'We recognize that not every pose is for everybody,'' said Robin Rothenberg, a yoga therapist who runs the Yoga Barn studios outside of Seattle. ''If you are a 20-something dancer, that is one thing and if you are a 50-year-old computer programmer, that's a different thing.''
Yoga therapy is nowhere near as popular as one-pose-fits-all classes. Still, in the last three years, membership in the International Association of Yoga Therapists, a trade group based in Prescott, Ariz., has almost tripled to 2,060, from 760.
But experts inside and outside the industry say yoga therapy should be approached with caution. In general, a person can practice as a yoga therapist after 200 hours of yoga teacher training, which might include basic training in anatomy, breathing, meditation and giving adjustments.
''Anybody can hang their shingle and say they are a yoga therapist,'' said Julie Gudmestad, a physical therapist who also practices yoga therapy in Portland, Ore. ''Buyer beware. I've seen some strange things done in the name of yoga therapy.''
Most reputable yoga therapists have additional credentials. Some are physical therapists or nurses or have completed two years of training in Iyengar yoga, which emphasizes anatomy and kinesiology.
Others have been certified as therapists by schools like Integrative Yoga Therapy or American Viniyoga Institute. The institute is run by Gary Kraftsow; applicants must have completed 500 hours of his teacher training. His course teaches the clinical applications of yoga for spine, joint and muscle problems.
There is no national credentialing system, and the lack of industry-wide standards worries doctors. ''You need some core set of certification that allows a patient to know that they are going to someone from whom they can reliably get appropriate treatment,'' Dr. James Weinstein, chairman of the department of orthopedic surgery at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the editor of the medical journal Spine. ''I have certainly seen patients asked to do positions that have made them worse.''
Just as certain conditions can be helped by extension, flexion, twisting or side bending, they can also be aggravated, said Robert Forster, a physical therapist in Santa Monica, Calif.
Some doctors advocate its use, however. ''I deeply believe in yoga and know the therapeutic value of yoga for health care,'' said Dr. Michael Sinel, an assistant professor of physical medicine and rehabilitation at the University of California, Los Angeles, who has a private practice in Santa Monica. In the next six months, he plans to start YogaMed, a company that will offer medical care and therapeutic yoga within the Yoga Works chain of studios.
There is some evidence that certain yoga poses help alleviate chronic back pain. A randomized, controlled study published in the Annals of Internal Medicine in 2005 found that participants who followed a pose sequence designed by a yoga therapist improved function more than those given a self-care book or sent to exercise class. (The 101 participants did not include patients with sciatica, previous back surgery or pregnant women.) Now, the National Institutes of Health has allocated $1.2 million for a second study to see, in part, if the results can be replicated on a larger scale.
Yoga therapists are not qualified to diagnose injuries, although some do, said Leslie Bogart, a yoga therapist in Santa Monica, who has worked as a nurse. ''Everybody should be seen by a medical person first, without question,'' Ms. Bogart said. ''Yoga should be an adjunct to'' treatment, not ''a replacement.''
A handful of doctor's offices already offer therapeutic yoga. Dr. Loren Fishman, who runs a physical medicine and rehabilitation practice in Manhattan, studied Iyengar yoga in India before medical school, and now recommends poses to patients like Sharon Williams.
Ms. Williams, 46, a development director at Dance Theater of Harlem, suffered from chronic shoulder pain. An M.R.I. revealed a torn rotator cuff, for which Dr. Fishman prescribed, among other things, a variation of a headstand using a chair. This pose can help relieve pain and restore range of motion, yoga therapists say, because of a method called muscular substitution -- training the body to avoid aggravating an existing problem by using other muscles.
This is plausible, said Dr. J. Hearst Welborn, an orthopedic surgeon in San Pablo, Calif. He added that actively trying to recover helps: ''Mind over matter has a huge effect on people's pain.''
Longtime yoga therapists say the next step for them is learning to work with doctors. Larry Payne, who has practiced since 1982 and is the founding president of the yoga therapist association, said therapists need to learn to read medical reports and to work in clinical settings. ''The doctors aren't interested in Sanskrit, they just want to be sure that yoga therapists they work with are properly trained,'' he said.
To that end, Dr. Payne created a yoga therapy teacher training course at Loyola Marymount University in Los Angeles, where students learn yoga therapy for both systemic and muscular ailments.
Dr. Payne and Dr. Richard P. Usatine also started yoga classes for medical students at the David Geffen School of Medicine at U.C.L.A. ''Once they understand and can feel the value of yoga personally, they can then suggest and prescribe it for their patients,'' said Dr. Usatine, a professor of family medicine at the University of Texas Health Science Center at San Antonio.
Nationwide, yoga is provided at 93 percent of 755 integrative medical centers, facilities offering under one roof both traditional medicine and other approaches to health and wellness. But it's unclear how many offer yoga therapy, said Cary Wing, the executive director of the Medical Fitness Association, a nonprofit group.
DEPRESSION
There are two types of depression. One type starts when a tragic event happens, usually with death or a separation, and the other type of depression appears suddenly and seems not to have any particular reason for manifesting.
In the first case, the solution is a philosophical comprehension of the meaning of life and the meaning of death; this helps depressed people accept their suffering without revolt. If this is your situation, I recommend you read my ebook Wisdom that was written specially in order to give support to people that are suffering constantly for any reason. You can find it on my website. The tragic loss of someone we love, especially if this person is young, is something we don’t every really overcome. The depression we feel seems unbearable – it seems we have no hope of finding relief! However, time will pass, and without understanding how, we always do overcome it, even though the sadness won’t disappear completely from our life.
But sometimes, this depression becomes worse instead of being slowly cured by time, and then we face despair. If things are this way for you, you certainly need more help. I’ve almost finished my ebook about dream decoding that is sure to help you immensely, but for the time being, I’ll help as much as I can through my articles in this ezine.
You have to have in mind that the human being is wild, and he can’t understand how far he actually is from psychical health. He has only a tiny human conscience which he knows only partially. Even this is mainly absurd, since it is based in his Ego and therefore, selfish. If he suffers a lot on this planet, it is because he is too absurd. He provokes his own suffering, and he destroys his personality instead of developing it. He makes only mistakes during his life, one after the other. He doesn’t learn anything from them, though, and so he doesn’t become better.
You have to understand that your suffering now is not something without any meaning that is only eroding you. You have to develop all your psychological functions, and become very sensitive in order to have psychical health. This process can only be completed through suffering. Sometimes we need to suffer more in order to learn more and to be transformed. What is happening to you now is not something without meaning, that could (or even should) be avoided.
You have to overcome your depression by accepting this suffering like a hero. This is the only way you can transform your nature and become a wise and balanced person that can help others overcome their problems too.
If your depression is unexplainable, then you more than anyone else, need psychotherapy through dream interpretation! This is the only safe and guaranteed way you have to be able to discover the real reason for your depression, since the unconscious that produces your dreams knows everything about you and your life.
I’ll try to give you some information about dream interpretation in my next articles, even though this can really be done properly only through a book or ebook - you’ll have to return to my past lessons several times, before proceeding. These articles are not chapters of a book; they each have a defined end. I can’t expect you to keep all of them and make a collection with my articles though, so that you can have an ebook about depression and how we can cure it. I don’t even know if you are a regular reader or if you are reading this ezine and one of my articles for the first time. So, I can’t explain too much this way. I can only give you short lessons, but they can still be very helpful if you take my advice seriously. I’ve helped many people overcome serious psychical diseases and serious existential problems.
I know that your depression is very serious, no matter whether it was provoked by a tragic event, or you don’t really know its origin. Of course it can’t be compared with the common sadness that we often hide from others, so that people won’t worry about us, we won’t have to give them embarrassing explanations that upset us, etc. But you have to behave as if your very serious and unbearable depression is only a common sadness that you have to hide from other people, mainly in order to make them feel better near you. You don’t want to be a burden for everyone because you are weak. Do you?
This way you’ll discipline yourself to acquire the resistance you need in order to completely overcome your depression eventually! So, stop complaining, hide the fact you only want to stay in a corner crying, and start pretending you are strong. The more you can show this attitude, the more you’ll really overcome the inner feelings of depression.
If however you feel you absolutely cannot do it, don’t insist. Perhaps your psychical condition won’t let you help yourself. You may need more help from outside. Ask for more help - tell everyone that you are desperate. Go to a psychologist, look for a person that is spiritual and can illuminate you, do something! Don’t just stay in this condition, without any action. Define your psychical illness and start curing your soul: either be a hero and start behaving as if you didn’t have any special problem, or accept that you need to be helped as a patient and follow exactly your doctor’s instructions, with devotion. You are going to reach psychical health, one way or the other. Everything depends on your attitude!
Beauty Tips You Have Never Heard
Your morning beauty regime takes you exactly 12 minutes. First comes the face wash, then the astringent, followed by the moisturizer. And the list goes on. It’s become such a chore, but wasn’t there a time when this routine was fun? Well, we decided to take you back to the days when applying makeup was a treat by giving you some innovative beauty tips and tricks to spice up your routine.
To get this insider information, we contacted Carmindy, resident make-up artist on TLC’s “What Not to Wear,” and author of The 5 Minute Face. Here are her 10 beauty tips to leave you feeling fresh and fabulous.
Beauty Tip # 1 - Make perfume last. A few spritzes of perfume in the morning will not carry you through the day, no matter how expensive your bottle may be. To make your scent last, try this beauty tip: put an unscented moisturizer on first and then spray on your perfume a few seconds later. “There’s so much alcohol in perfume,” Carmindy explains, “that if you spray it on dry skin, a lot of times it evaporates so quickly. But if you have moisturizer on your skin it adheres much better.”
Beauty Tip # 2 - Lip gloss without the goop. Instead of directly putting the tube of gloss to your lips, Carmindy recommends adding an extra step to ensure less stickiness. “I like to put lip gloss on my fingertips first and then just pat it onto the flesh of my lips. And this way you’ll get a little bit of glow, but it won’t be too goopy.” Also, try a moisturizing lipstick or a lip stain first before you add the gloss to make sure the color stays put.
Beauty Tip # 3 - A sweet scrub. “The best exfoliate in the world is regular white table sugar.” If every scrub out there contains some form of sugar, like “Almond Sugar Scrub” or “Brown Sugar Scrub,” why not just use what’s in your kitchen cupboard? “What happens is that the small crystals dissipate in water so they don’t tear your skin.” And, if you have sensitive skin, don’t fret. “It even works better because with other products you might not like a fragrance or a lot of ingredients,” states Carmindy. When you’re in the shower, all you have to do is lather your face up like normal and then get a handful of sugar and scrub your face. And if you run out you’ll be able to ask your cute neighbor for a spot of sugar!
Beauty Tip # 4 Ditch your spot concealer. Instead of fumbling around your makeup bag for multiple concealers in the morning, just stick to one, advises Carmindy. The reason why? Because you can actually use the foundation stuck to the top of the cap of your liquid all-over concealer as your spot-treatment. “It oxidizes there so it becomes a little bit thicker.” Plus, she says, “It’s the same shade as your foundation, so it will instantly erase your blemish.” To apply, just take a small tip concealer brush and dip into the cap of your foundation, or the nozzle if you use a spray. Then brush it on the spots and you’re ready to go. Now it will be a good thing when your foundation lid gets cakey.
Beauty Tip # 5 - Recycle: Good for the earth, good for your lips. What are you supposed to do when your four best lipsticks are almost gone and your finger is tired from scraping out the remnants below? Carmindy suggests combining the half-used sticks into your own lip pallet. “Go to the drug store and purchase a plastic pill box and dig out the lipstick that’s left in the tubes. Then put each color into a different little section of the pill box.” You can mix and match the colors or even put Vaseline in one of the sections to make your own lip gloss.
Beauty Tip # 6 Celebrity-size lips. To get fuller lips people often outline them with a pencil, but most of the time it looks noticeable and unsophisticated (especially when the lipstick comes off and you’re left with just that awful line). To get invisible enhancement, Carmindy recommends you take a Q-tip and dip it in a little bit of white shimmer eye shadow and lightly trace the outside of your lips. “What will happen is that the shimmer will capture the light and make your lips seem larger.” You won’t be able to see it, but the slight glimmer will do the trick. Great if you don’t have any collagen handy.
Beauty Tip # 7 - Bronzed but not dirty. Dusting bronzer all over your face can make you look like you’ve been rolling around in the sand box all day or have picked up a part time job as a chimney sweep. Carmindy prefers a spray bronzer to get the appearance of a fresh summer tan. “I like to spray a sponge and then what I do is just push it onto the skin—on the temples and then right underneath the cheekbones because this is kind of where the sun would kiss your face. And if you like powder bronzer you can apply it in the same places too.”
Beauty Tip # 8 - Brow breakthrough. If you’ve been awarded barely there eyebrow DNA, you’ve probably tried everything to make them visible—and figured out that most of the time these products end up rubbing off by the end of the day. If you still want eyebrows at five p.m., Carmindy advises buying waterproof liquid eyeliner that matches your hair color like black, brown or taupe. Then, she says, “You can take an angled brush and feather the liquid eyeliner on to your eyebrows and it will stay put all day long. It looks more natural than a pencil and stays longer.” It’s a win-win.
Now if you’re like me and are on the opposite end of the brow spectrum you might need some help keeping your out-of-control brows in check. To do this, “Take a spooly brush or an old tooth brush, put a little hair gel on there and just brush it onto your eyebrows to have them stay put.”
Beauty Tip # 9 - Not your average smoky eye. “What I like to do is take a color like a navy blue or a sparkling kind of burgundy purple and just line the inside rim and right along the upper and lower lash line and then smudge it with a Q-tip. That way, there’s no eye shadow pushing the eye back, but you still have the smoky effect because they’re lined with color. If you have deep-set eyes, Carmindy advises you to avoid putting dark shadow on your eyelids because it will make them seem even more pushed back. “There are so many ways to do a smoky eye, but people always think there’s only one way to do it.”
Beauty Tip # 10 - Save time and eye shadowRunning late in the morning? The best thing you can put on is white shimmering highlight powder. “If you highlight three key places you set of the planes of your face—you don’t even need eye shadow,” says Carmindy. These key spots are underneath the eyebrow, on the inside corner of the eye and on top of the cheekbone. “It brings sparkle to the eye; it lifts up the lid and draws attention to the top of the cheekbone.” Now all you need is a big cup of coffee to actually feel as awake as you look.
Who says your beauty routine has to be boring—especially now that you can take a box of sugar with you in the shower or turn a pill box into a personalized lip pallet. With these beauty tips You just might have to rethink your 12 minute routine after all.
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Barbara Harrington discloses some of her best make up tips when it comes to eye brow
EyeBrows: Creating the Frame of the Eye
The key purpose for eyebrows is to prevent moisture (such as perspiration or rain) from going into the eye. The shape of the eyebrow and the direction which the eyebrow hairs point make sure that this moisture flows sideways around the eye to help protect the eye. Plus, the protruding brow ridge and the eyebrows also help shade the eyes from sunlight.
Eyebrows create a frame for the eye. Our eyebrows are linked to our expressions in amazement, surprise or anger.
So....It is important to discover what the best shape for your eyebrows is without sacrificing their natural appearance.
To create the best shape, and have maximum control, tweezing is best. However, that is not say you can't have your eyebrows waxed, but you lose on the control aspect.
Eyebrows - Basics 101
The beginning of the brow should align with the center of the nostril.
The arch of the brow should fall at the back third of the eye.
The eyebrow should follow the length of the eye but it shouldn't extend into the temple area. The basic rule is that the front part of the brow should never drop below the back part of the brow.
The beginning of the brow should align with the center of the nostril.
The arch of the brow should fall at the back third of the eye.
The eyebrow should follow the length of the eye but it shouldn't extend into the temple area. The basic rule is that the front part of the brow should never drop below the back part of the brow.
Tips To Thicken Thin Eyebrows:
Eyebrow should begin parallel to inner corner of eye and end just beyond eye.
Eyebrow is fullest at Nose Bridge, gently arches and softly tapers at the end.
Start at the bridge of the nose with EyeBrow; apply color over entire eyebrow area in short hair-like strokes.
Eyebrow should begin parallel to inner corner of eye and end just beyond eye.
Eyebrow is fullest at Nose Bridge, gently arches and softly tapers at the end.
Start at the bridge of the nose with EyeBrow; apply color over entire eyebrow area in short hair-like strokes.
Tips for Full Eyebrows::
The beginning of the eyebrow should be in line with inner corner of the eye and end just beyond eye.
Use a feather-touch stroke with brow color to fill in any areas with sparse hair.
Blend with eyebrow brush.
The beginning of the eyebrow should be in line with inner corner of the eye and end just beyond eye.
Use a feather-touch stroke with brow color to fill in any areas with sparse hair.
Blend with eyebrow brush.
Brow Tips: To Tweeze or Not to Tweeze...That is the question
Most of us need to tweeze (at least a little bit), to allow the brow to suggest a more finished look to the face. Besides the general rule of using a very good tweezer, it's a good idea to go to a reputable eyebrow professional at least once. It's worth the $12.00 to $15.00 to have her decide what's right for your face and establish the line for you. You can take over from there.
The reason for going to a professional is so that you know which hairs you need to tweeze, and which ones to leave alone. Knowing which ones to tweeze really makes all the all the difference in an attractive brow vs. one that isn't.
If you don't do this professionally, try different shapes over your brow first to get the right one for you first. And follow the stenciled shape the best you can.
To help you really see what you are doing, use a good magnifying mirror (at least with 5x magnification).
Most of us need to tweeze (at least a little bit), to allow the brow to suggest a more finished look to the face. Besides the general rule of using a very good tweezer, it's a good idea to go to a reputable eyebrow professional at least once. It's worth the $12.00 to $15.00 to have her decide what's right for your face and establish the line for you. You can take over from there.
The reason for going to a professional is so that you know which hairs you need to tweeze, and which ones to leave alone. Knowing which ones to tweeze really makes all the all the difference in an attractive brow vs. one that isn't.
If you don't do this professionally, try different shapes over your brow first to get the right one for you first. And follow the stenciled shape the best you can.
To help you really see what you are doing, use a good magnifying mirror (at least with 5x magnification).
Go Slow - Check your work.
Your brow should align with the center of the nostril.
Eyebrows should follow the length of the eye, and not extend into the temple area.
Avoid over tweezing!
Don't tweeze a thin line thinking it will make your eyes look larger...because it won't and it wall be not easy to correct.
To make it less painful, tweeze immediately after showering.
By the way, don't tweeze too often. Once or twice a week should suffice, as the idea is to control the new growth so the brows don't lose their shape too quickly.
And Ladies...Please never, Never, NEVER shave or EVER bring a razor near the delicate eye area! Shaving eyebrows can cause skin discolorations and your brows never grow back the same.
Your brow should align with the center of the nostril.
Eyebrows should follow the length of the eye, and not extend into the temple area.
Avoid over tweezing!
Don't tweeze a thin line thinking it will make your eyes look larger...because it won't and it wall be not easy to correct.
To make it less painful, tweeze immediately after showering.
By the way, don't tweeze too often. Once or twice a week should suffice, as the idea is to control the new growth so the brows don't lose their shape too quickly.
And Ladies...Please never, Never, NEVER shave or EVER bring a razor near the delicate eye area! Shaving eyebrows can cause skin discolorations and your brows never grow back the same.
Diet & your skin
When it comes to solving problems, we tend to look for the shortest distance between the symptom and its cause. Skin problems? It must be what we're doing to our skin on the outside, right? And while actual skin-care is undoubtedly critical, it needs to be considered as part of a larger, more holistic approach to overall health and wellbeing. What we feed ourselves plays as important a role in the health of our skin as it does the rest of us. And because our skin takes such a beating from our often unforgiving environment, we need to make sure it gets what it needs from the inside in order for it to continue to protect us on the outside. A diet rich in protein and essential fatty acids is a good place to start. Nuts (especially almonds and hazelnuts, rich in Vitamin E), whole-grains, and soy-based products are all excellent sources of many of the important building-blocks for healthy skin. Also, foods such as broccoli, spinach, carrots, and sweet potatoes are extremely rich in beta carotene, nature's most easily assimilated source of vitamin A. A powerful antioxidant, beta carotene is capable of binding up reactive oxygen -- a free radical produced by exposure to UV light, which has been shown to contribute to premature aging by interfering with the development of our skin's collagen. Plenty of fruits and vegetables, as well as things like antioxidant-rich green tea, help to form an effective diatary regimen invaluable for maintaining your overall health, as well as that of your skin. Complex B vitamins, such as those found in brewer's yeast (often sold as nutritional yeast in health food stores), have long been recognized as having a powerful, healing effect on skin. Brewer's yeast has a complex, nutty taste and gives great depth of flavor to soups, stews, and sauces (it also, incidentally, is great on popcorn!). There is no doubt that healthy skin begins with a diverse diet rich in unprocessed, natural and organic ingredients and healthy preparations. With these working for you from the inside, your external skin-care regimen becomes much more effective.
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