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Bill Clinton’s public health, cost-bending message thrills health IT folks at HIMSS

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the

 

The future of sensors in health care – passive, designed, integrated

Here’s Ann R., who is a patient in the not-too-distance-future, when passive sensors will be embedded in her everyday life. The infographic illustrates a disruption in health care for people, where data are collected on us (with our permission) that can help us improve our own self-care, and help our clinicians know more about us outside of their offices, exam rooms and institutions. In Making Sense of Sensors: How New Technologies Can Change Patient Care, my paper for the California HealthCare Foundation, I set out to organize the many types of sensors proliferating the health care landscape, and identify key

 

The Accountable Care Community opportunity

“ACOs most assuredly will not…deliver the disruptive innovation that the U.S. health-care system urgently needs,” wrote Clay Christensen, godfather of disruptive innovation, et. al., in an op-ed in the Wall Street Journal of February18, 2013. In the opinion piece, Christensen and colleagues make the argument that Accountable Care Organizations (ACOs) as initially conceived won’t address several key underlying forces that keep the U.S. health care industry in stasis: Physicians’ behavior will have to change to drive cost-reduction. Clinicians will need “re-education,” the authors say, adopting evidence-based medicine and operating in lower-cost milieus. Patients’ behavior will have to change. This requires

 

Physicians like mobile health apps for patient health – eClinicalWorks on transformational path

A vast majority – 9 in 10 physicians – like mobile health (mHealth) apps, especially when tied to electronic health records (EHRs). eClinicalWorks surveyed physicians in January 2013, and found physicians bullish on mobile health apps for patient benefit – not just for their own office productivity and workflow. Specifically, – 93% of physicians say mobile health apps can improve patients’ health outcomes – 89% of physicians would recommend an mHealth app to a patient – 58% of doctors note a key mHealth benefit is providing patients with appointment alerts and reminders – 2 in 3 physicians say mHealth apps

 

Managing the abundance of mHealth apps in the urban flea market

The proliferation of mobile health (mHealth) apps appears to be an abundant cornucopia of “lite” tools that look simple to access and easy to use. But this growing menu of a la carte choices that promise to keep us healthy, track our numbers, and access useful health information can also, in the words of three Dutch health researchers, “drive us crazy.” Why mobile health app overload drives us crazy, and how to restore the sanity, by Lex van Velsen and colleagues, makes the case that the plethora of mHealth apps available in online app stores is a fragmented, disorganized marketplace

 

The more engaged a patient is, the lower their costs

There are many ways to measure and express “patient engagement.” One such metric is “patient activation,” innovated by Dr. Judith Hibbard, long affiliated with the University of Oregon. Dr. Hibbard has written extensively about the Patient Activation Measure, PAM, first described in 2004. She and a team of researchers have determined that the higher a patient’s PAM score, the lower their health costs. Hibbard et. al. published these findings in the February 2013 issue of Health Affairs, which is entirely devoted to patient engagement – a top topic in Health Populi. The team analyzed the medical records of 33,163 patients

 

The interoperability of consumer mHealth – reflecting on Jawbone + Massive Health + Visere

Consumers want multiple functions on single devices, smooth transitions from one screen to another, and value-laden experiences in the post-recession economy. I wrote about this phenomenon during the week of the 2013 Consumer Electronics Show, highlighting Accenture’s survey on consumer attitudes toward technology — the connected home as consumer medical home. In the fast-evolving mobile health (mHealth) era, the consumer-facing suppliers are fast-responding to these customer demands. This is fostering consumer-centered interoperability in mHealth. On the health care system and professional side of health IT, getting to interoperability remains elusive and slow-going, with a customer base (hospitals, physicians) that’s not

 

Health and consumer spending may be flat, but consumers hard hit due to wage stagnation & self-rationing

There’s good news on the macro-health economics front: the growth rate in national health spending in the U.S. fell in 2011, according to an analysis published in Health Affairs January 2013 issue. Furthermore, this study found that consumers’ spending on health has fallen to 27.7% of health spending, down from 32% in 2000, based on three spending categories: 1. Insurance premiums through the workplace or self-paid 2. Out-of-pocket deductibles and co-pays 3. Medicare payroll taxes. A key factor driving down health spending is the growth of generic drug substitution for more expensive Rx brands. Generics now comprise 80% of prescribed

 

We are all health deputies in the #digitalhealth era: live from the 2013 Consumer Electronic Show

Reed Tuckson of UnitedHealthGroup was the first panelist to speak at the kickoff of the Digital Health Summit, the fastest-growing aspct of the 2013 Consumer Electronics Show (#2013CES). Tuckson implored the spillover audience to all, “self-deputize as national service agents in health,” recognizing that technology developers in the room at this show that’s focused on developers building Shiny New Digital Things have much to bring to health. As Andrew Thompson of Proteus Medical (the “invisible pill” company) said, “we can’t bend the health care cost curve; we have to break it.” This pioneering panel was all about offering new-new technologies

 

Consumers want digital communications from providers, from payment reminders to patient care via email

85% of U.S. health consumers say that emails, text messages, and voicemails are at least as helpful as in-person or phone conversations with health providers, according to the TeleVox Healthy World study, Technology Beyond the Exam Room. The study was based on surveys conducted with over 2,200 health providers across specialties, and 1,015 U.S. adults over 18. Furthermore, one in 3 consumers admit to being more honest when talking about medical needs via automated voice response systems, emails or texts than face-to-face with a health provider. And 3 in 10 consumers believe that receiving digital health communications from providers such

 

Growing use of online health tools is replacing going to the doctor for more patients

  41% of Americans are comfortable using websites that allow them to check health symptoms. Furthermore, 25% of people trust online symptom checkers, mobile apps and home-based vital sign monitors as much as they trust their doctor. In fact, roughly the same proportion uses these tools instead of going to see the doctor, according to a consumer survey from Royal Philips Electronics (Philips). The infographic illustrates some of Philip’s top-line findings from this poll, conducted among 1,003 U.S. adults 18 and over in November 2012. Over one-third of Americans also believe that technology allows them to monitor their health — a

 

The physician time-squeeze and burnout: just-in-time information is part of the solution

  One in two doctors is burned out. Physicians are seeing more patients in a day and spend less time with each of them. This leads to job burnout, and greater probability for medical errors and eventual liability challenges, along with feeling pushed toward early retirement. In a study published in August 2012 in the Archives of Internal Medicine, Mayo Clinic researchers learned that physicians are more burned out than workers in any other profession. And those at greatest risk of “being on a hamster wheel,” as Dr. Jeff Cain, president-elect of the American Academy of Family Physicians describes the scenario, are primary

 

Nurses, pharmacists and doctors rank top in honesty, says Gallup poll

  Nurses, pharmacists and doctors rank tops with Americans when it comes to honesty and ethics. Most people also rate engineers, dentists, police officers, clergy and college teachers as high on honesty metrics. Lawmakers (THINK: Congress) and car salesman fall to the bottom of the honesty-and-trust roster, who only 1 in 10 Americans believe act with honesty and integrity. Other low-ranking professions on this list are HMO managers, stockbrokers, and folks in the advertising business. Welcome to this year’s Gallup Poll on consumers’ perceptions of honesty and ethics in 22 professions in the U.S. Gallup measures six health care professions

 

Mobile is the new black in health care

Mobile technology will change the delivery of health care, according to 2 in 3 health IT execs polled in the 2nd Annual HIMSS Mobile Technology Survey, sponsored by Qualcomm Life. Only 2% of health IT management says mobile won’t impact the delivery of health care in the future. This week finds the mHealth Summit convening in Washington, DC, hosting some 3,000 interested stakeholders looking at the intersection of mobile devices and platforms and health and health care. The 2012 theme is Connecting the Mobile Health Ecosystem, and the exhibitor area of the Summit speaks to the broadening of that ecosystem, including

 

Consumers seek emotional connections with health care

83% of consumers would pay more for a product or service from a company they feel puts them first, finds rbb Public Relations in their 2012 Nationwide Breakout Brand Survey. Emotional connections matter most in health care, say 76% of U.S. consumers, followed by banks (63%), professional services (62% – think: accountant, financial planner, estate lawyer), travel (56%), insurance (55%) and autos (52%). Interestingly, apparel and beauty rank the lowest in the poll – with only 18% and 19% of consumers looking for emotional connections from those industries. The top 10 breakout brands on the emotional front are Apple Amazon

 

In sickness and in health: consumers expect doctors to be wellness coaches, too

4 in 5 health consumers expect doctors not only to treat them when they’re sick, but to keep them healthy. “In sickness and in health” now morphs over to the doctor-patient relationship, beyond the marriage vow. Better Health through Better Patient Communications, a survey from Varolii, finds that people are looking for health, beyond health care, from their physicians. Varolii is a customer interaction company that claims to have interacted with 1 in 3 Americans through some sort of company communication: they work with major Fortune 1000 companies, including banks, airlines, retail, and, yes, health care. They recently attracted  a

 

What Jerry the Bear means for Health 2.0

A teddy bear in the arms of a child with diabetes can change health care. At least, Jerry the Bear can. Yesterday kicked off the sixth autumn mega-version of the Health 2.0 Conference in San Francisco. Co-founded by Matthew Holt and Indu Subaiya, a long-time health analyst and physician, respectively, this meeting features new-new tools, apps and devices aimed at improving individual and population health, as well as health processes and workflows for physicians, hospitals, pharma, and other stakeholders in the health care ecosystem – even health lawyers, who met on October 7 to discuss up-to-the-minute  e-health law issues. Yesterday was

 

Free statins at the grocery: retail health update

I spotted this sign yesterday at my local Wegmans, the family-owned grocery chain founded in upstate NY and growing down the northeast corridor of the U.S. Many months ago, a similar sign promoted “free antibiotics” at the store. What does a grocery chain’s pharmacy doling out “Free” [asterisked] generic Lipitor mean to the larger health ecosystem? On the upside, health is where we live, work, play and pray, as Dr. Regina Benjamin, the Surgeon General, has said. This has become a mantra for us at THINK-Health, and regular Health Populi readers may be tiring of my repeated use of this

 

Employees will bear more health costs to 2017 – certainty in an uncertain future

Amidst uncertainties and wild cards about health care’s future in the U.S., there’s one certainty forecasters and marketers should incorporate into their scenarios: consumers will bear more costs and more responsibility for decision making. The 2012 Deloitte Survey of U.S. Employers finds them, mostly, planning to subsidize health benefits for workers over the next few years, while placing greater financial and clinical burdens on the insured and moving more quickly toward high-deductible health plans and consumer-directed plans. In addition, wellness, prevention and targeted population health programs will be adopted by most employers staying in the health care game, shown in

 

Lab tests and knowing our numbers can inspire patient engagement

One-half of the members of Kaiser Permanente use the plans’ personal health record system, MyHealthManager. The most-used function of MyHealthManager is accessing lab results, according to KP. Now that Quest, the lab and health information company, has launched the mobile phone app, Gazelle, more health citizens will have access to lab test results. This could be a health-activating opportunity inspiring patient engagement. While Gazelle is a fully functional personal health record (PHR), it’s the connection to lab test results that’s the lightbulb moment. PHRs have been available to health consumers for over a decade. There are millions of users of

 

Antidepressant Nation – and how computerized CBT can help primary care in America

The antidepressant market is worth $20 billion in the U.S. Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005-2008 and the most frequently used by people age 18-44 (according to the National Center for Health Statistics). About one in 10 Americans age 12 and over takes an antidepressant medication. But there is little evidence that pharmacotherapy should be used as a first line of treatment for mild to moderate depression. Why are anti-depressants the first line of treatment for mild to moderate depression in the U.S.? The answer lies in the fact that

 

Our social network schizophrenia: how “reluctant individualism” impacts health care

While 2 in 3 U.S. adults are active on social media, we are skeptical about trustworthiness of the content we find there. Welcome to the 13th quarterly Heartland Monitor Poll from Allstate and National Journal, surveying how U.S. adults look at social media, trust, and the political future of the nation. The Poll surveyed, by landline and cell phone, 1,000 U.S. adults over 18 in May 2012. The most common social network used is Facebook, among 51% of U.S. adults, followed by Google+ (28%), Twitter (13%), LinkedIn (12%), Pinterest (6%), and MySpace (5%). While Americans are drawn to using social

 

Patients in emerging countries value mHealth, but sustaining mHealth behaviors is tough

Half of patients globally expect that mobile health will improve health care. These health citizens expect that mobile health will help them manage their overall health, chronic conditions, how they manage their medications and measure and share their vital health information. Welcome to the new mobile health world, a picture captured in PwC’s report, Emerging mHealth: Paths for growth, published in June 2012 and written by the Economist Intelligence Unit. Patients’ views on mHealth are bullish, and while most doctors and payors share that vision, they also expect mHealth to come into focus more slowly, recognizing the institutional, cultural and

 

Statins, food and a mobile app: Pfizer and Eating Well partner up as generic Lipitor hits the market

On May 23, 2012, Pfizer announced its teaming with EatingWell magazine to launch a mobile app for patients on Lipitor. Eight days later, on May 31, 2012, generic versions of Lipitor will hit the market. Lipitor is the best-selling drug in pharmaceutical history, to-date. Sales of the product top $125 billion. While generic atorvastatin has been available in the U.S. since November 2011 from two manufacturers, low prices for the generic will drop to $10 or less for a month’s supply at the end of May. This is Pfizer’s first foray into a prescription drug-affiliated app. The free mHealth app,

 

The pharmaceutical landscape for 2012 and beyond: balancing cost with care, and incentives for health behaviors

Transparency, data-based pharmacy decisions, incentivizing patient behavior, and outcomes-based payments will reshape the environment for marketing pharmaceutical drugs in and beyond 2012. Two reports published this week, from Express Scripts–Medco and PwC, explain these forces, which will severely challenge Pharma’s mood of market ennui. Express-Scripts Medco’s report on 9 Leading Trends in Rx Plan Management presents findings from a survey of 318 pharmacy benefit decision makers in public and private sector organizations. About one-half of the respondents represented smaller organizations with fewer than 5,000 employees; about 20% represented jumbo companies with over 25,000 workers. The survey was conducted in the

 

Your doctor’s appointment on your phone: out of beta and into your pocket

You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA. In enabling mobile physician visits, American Well and Consult A Doctor join Myca, which has offered mobile phone-based visits for clients for at least two years to employer clinic customers. In April 2010, my report, How Smartphones Are Changing Healthcare for Consumers and Providers, talked about Myca’s work with Qualcomm: the telecomms company armed traveling employees with mobile phones that could connect

 

Health consumers’ digital adoption gets more social, approaching nearly half of U.S. consumers

Nearly 1 in 2 U.S. adults now uses social media in health, according to Manhattan Research’s latest look into Cybercitizens, fielded in Q311. That 45% of U.S. health consumers use social media in health is a significantly higher percentage than recent studies fielded by PwC and Deloitte, which have found about 1 in 3 consumers using social media for health. Manhattan Research defines social media use in health as having created or consumed health-related user-generated content on blogs, social networks, health ratings websites, online health communities and message boards, or patient testimonials. Key findings are that, 14% of health-social media folks are

 

Americans continue to self-ration health care in the economic recovery

Even though Inside-the-Beltway economists have said The Great Recession of 2007 is officially over, it doesn’t look that way when you ask consumers about health spending in 2012, based on results from a survey conducted on behalf of the American Osteopathic Association (AOA). One in 5 U.S. adults is trying to lower their personal health spending. One in four is seeking free or alternate sources of health care. Overall, 1 in 5 people says their health has been negatively impacted by the economy. The AOA discovered that people in the U.S. whose health has been negatively impacted by the economic downturn were

 

On the road to retail health: healthcareDIY and primary care, everywhere

At the ConvUrgent Care Symposium in Orlando, attendees from the worlds of clinics, ambulatory care, hospital beds, pharmacies, medical devices, life sciences, health information, health IT, health plans, academic medical centers and professional medical societies came together to share and learn about the morphing landscape of retail health. The topline message: primary care is everywhere, and based on the response to my keynote talk this morning, every stakeholder segment gets it. My mantra, courtesy of the U.S. Surgeon General Regina Benjamin: don’t look at health in isolation, that is, where the doctor and hospital are. Health happens wherever the person

 

Health spending in America – self-rationing slows cost increases

The Big Headline under the banner of Health Economics this week is the statistic that growth in U.S. national health spending slowed to an anemic 3.9%  in 2010 — the slowest rate of growth in the 51-year history of keeping the National Health Expenditure Accounts.   Before American policymakers, providers, plans and suppliers pat themselves on their collective back on a job well-done, the heavy-lifting behind this story was largely undertaken by health consumers themselves in the form of facing greater co-pays, premiums and prices for health services — and as a result, self-rationing off health care services and utilization, which

 

Consumers are at the center of the business of health and wellness

The market for health and wellness has traditionally included over-the-counter medicines, gym memberships, and vitamins/minerals/supplements. In 2012, the boundaries of health/wellness are blurring beyond these line items toward preventive medical services and consumer electronics. This morphing market is discussed by Cambridge Consultants in their report on the disruptions driving The Business of Health & Wellness: Engaging consumers and making money. Cambridge correctly introduces this analysis by saying that economics, the growing prevalence of chronic diseases, an aging population, and demand consumers are shaping health/wellness, “recharacterizing” the market as one driven by “life events.” Cambridge sees that health consumers are changing their spending

 

UK finds telehealth reduces mortality by 45%; telehealth’s tipping point in 2012

As we approach 2012, we health prognosticators like to forecast what we’ll likely see in 2012. One of the for-certain trends will be the uptake of telehealth programs, which will be publicly, privately, and jointly-funded. The business case is clear for telehealth, both in the U.S. and globally. Jon Linkous, CEO of the American Telemedicine Association, told the mHealth Summit last week that, the “shift in the way healthcare is paid will put providers in driver’s seat when it comes to choosing the best way  to deliver healthcare and whether or not to use telemedicine.” The forces are converging for telehealth

 

Designing health technology for people at home

The Internet, broadband, mobile health platforms, and consumers’ demand for more convenient health care services are fueling the development and adoption of health technologies in peoples’ homes. However, designing products that people will delight in using is based on incorporating human factors in design. Human factors are part of engineering science and account for the people using the device, the equipment being used, and the tasks the people are undertaking. The model illustrates these three interactive factors, along with the outer rings of environments: health policy, community, social, and physical. Getting these aspects right in the design of health technologies meant for

 

Consumer electronics comes to health care — but don’t overestimate consumer demand just yet

More people with higher levels of concern about their health feel they are in good health, see their doctors regularly for check-ups, take prescription meds “exactly” as instructed, feel they eat right, and prefer lifestyle changes over using medicines. And 40% of these highly-health-concerned people have also used a health technology in the past year. At the other end of the spectrum are people with low levels of health concern: few see the doctor regularly for check-ups, less than one-half take their meds as prescribed by their doctors, only 31% feel they eat right, and only 36% feel they’re in

 

The economy’s impact on personal health: shopping and social

The recessionary, sluggish U.S. economy has had an impact on Americans’ mental and physical health. The least healthy citizens have experienced a disproportionately hard hit on their health and health care. But necessity being the mother of invention, some people are re-inventing their personal workflows in health care — and many of these tactics may well benefit their health in the long run. The Economy and Health: 10 Observations is the analysis from Euro RSCG‘s survey of U.S. adults’ views on their personal health in light of the continued economic downturn. The first chart shows the economy’s impact on the overall mood of

 

Employers’ health plans look to behavior change, while accelerating the premium cost shift to employees

The new mantra for employers who sponsor health benefits is: “a healthy workplace leads to a healthy workforce.” Employers that sponsor health plans are now in the behavior change business, according to Aon’s 2011 Health Care Survey. Health plans are tightly focusing on wellness, motivating and sustaining positive personal health changes, with carefully designed incentives (carrots and sticks) informed by behavioral economics. The paradigm is value-based insurance design (VBID) that removes barriers to essential, high-value health services to bolster treatment adherence, improve productivity, and reduce overall medical costs. The top five priority tactics for employers in health are: To offer incentives

 

Patients feel out of the Rx drug development process: why participatory health in pharma is important

“Value” in prescription drugs is first and foremost about outcomes, in the eyes of physicians and biopharma. For managed care, “value” is first about safety, then patient outcomes. However, although one-third of patients managing a chronic condition cannot define “value” in health care, 9 in 10 say that prescription drugs are “valuable” to their health and wellbeing. In fact, 80% say that the money they spend on prescription medications is “worth it.” Yet patients feel largely out of the prescription drug development process. These findings come from Quintiles research report, The 2011 New Health Report, subtitled: exploring perceptions of value and collaborative relationships among

 

Health care where we live, play, work and pray: how Ford & Toyota’s mhealth pilots fit into Whole Health

In an interview in March 2011 with the Los Angeles Times, Dr. Regina Benjamin, the U.S. Surgeon General, said, “We can’t look at health in isolation. It’s not just in the doctor’s office. It’s got to be where we live, we work, we play, we pray. If you have a healthy community, you have a healthy individual.” Ford’s announcement last week that the automaker would team up with WellDoc to incorporate mobile health sensors into the company’s SYNC connectivity system  follows Toyota’s mhealth concept, the RiN, launched in 2007. Among various applications envisioned at this preliminary stage: Glucose monitors, from Medtronic, will

 

Botox over preventive health: health consumers have spoken, delaying diagnoses

Americans are opting for Botox and cosmetic procedures more than colonoscopies and cancer tests, according to a story in Reuters. This trend makes companies like Allergan, makers of Botox and the Lap-Band for gastric surgery, very happy indeed. Plastics and gastric bypass surgeries are back up to pre-recession levels as of 2Q11. However, for companies and providers in other segments of the health care and surgery value-chain, prospects for bounceback in 2011 aren’t as promising. Various indices on consumers’ health care sentiment — such as the Thomson-Reuters Consumer Healthcare Sentiment Index and the EBRI Health Confidence Survey, show U.S. consumers’ perceptions of their ability to

 

ePrescribing continues to challenge physicians – but can be a link for patient engagement

  About 1.3 million people in the U.S. experience a medication error each year, which are preventable events that may cause or lead to inappropriate medication use or harm a patient, any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Two very common causes of medication errors are illegible handwriting by prescribers and misplaced decimal points on prescription forms. Twenty percent of adverse drug events lead to life-threatening circumstances, according to The Leapfrog Group.  The costs of medication errors has been

 

Are health innovation and cost-reduction mutually exclusive? Insights from West Wireless’s Health Care Innovation Day DC

Representatives from eight U.S. Federal government agencies, including the FDA and Veterans Administration, among others; health financiers (VCs, angels); health tech start-ups; providers, life science companies, and analysts, attended the Health Care Innovation Day DC sponsored by West Wireless Health Institute on April 28, 2011. The meeting had the tagline, A Discussion with the FDA, setting the stage for a day-long consideration of the role of regulation vis-a-vis health innovation. The $2.5+ trillion question (annual spending on health care in the U.S.) is: can innovation drive making health care “cheaper?” This was the underlying theme of the panel on which I sat

 

The intent-behavior gap is what stands between the doctor and optimal health outcomes

The environmental landscape for pharmaceutical manufacturers and retail pharmacies is marked with landmines, yield signs, and cautionary wild cards: health reform, supply chain dynamics, specialty drug pricing, pharmacogenomics, and the high burden of chronic disease among them. But the crux of the challenge for achieving optimal outcomes has less to do with these factors than it does with consumer behavior: specifically, the chasm between what people/health consumers say they want versus what people actually do. Express Scripts calls this “The Intent-Behavior Gap,” and it’s the theme of the company’s 2010 Drug Trend Report, Complex Challenges, New Solutions. The cost of sub-optimal pharmacy behaviors are huge: in 2010, pharmacy-related waste

 

Nearly 1 in 2 women delayed health care in the past year due to costs – the economic impact on a woman’s physical, emotional, and fiscal health

Nearly 1 in 2 women put off seeking health care because the cost was too high. The kinds of services delayed included visits to the doctor, medical procedures, and filling prescription medications. The fourth annual T.A.L.K. Survey was released this week by the National Women’s Health Resource Center (NWHRC), focusing on the declining economy and its impact on women and three dimensions of their health — physical, emotional, and fiscal. 40% of women say that their health has worsened in the past five years due to increasing stress and gaining weight, according to the survey. One of the most interesting