A blog covering the health/care ecosystem and people.

As people take on self-service across all aspects of daily living, self-care in health is growing beyond the use of vitamins/minerals/supplements, over-the-counter meds, and trying out the blood-pressure cuff in the pharmacy waiting for a prescription to be filled. Today, health consumers the world over have begun to engage in self-care using digital technologies. And this isn’t just a phenomenon among people in the Millennial generation. Most seniors who regularly use technology (e.g., using computers and mobile phones) are also active in digitally tracking their weight, for example, learned in a survey by Accenture. Older people who use technology in daily

This post is written as part of the Disruptive Women on Health’s blog-fest celebrating the 2014 mHealth Summit taking place 7-11 December 2014 in greater Washington, DC. Women and mobile health: let’s unpack the intersection. On the supply side of the equation, Good Housekeeping covered health tracking-meets-fashion bling in the magazine a few weeks ago in article tucked between how to cook healthy Thanksgiving side dishes and tips on getting red wine stains out of tablecloths. This ad appeared in a major sporting goods chain’s 2014 Black Friday pre-print in my city’s newspaper last week. And along with consumer electronics brand faves like

Moore’s Law is coming to medicine. And it will look and feel a lot like Uber: with rich technology underpinning,  consumer-service oriented and friendly, and shaking up the professionals at the front line of the business (from taxi drivers to physicians). Eric Topol, physician and editor-in-chief at Medscape, told a standing-room-only audience at the kickoff of the 8th annual Health 2.0 Conference that the democratization of health care is coming based on consumers’ use of eight drivers: sensors, labs, imaging, physical exams, access to medical records, transparency of costs, and digital pills. Dr. Topol referred to the cover ot TIME

The supply side of telehealth has been readying itself for nearly a decade. The demand side appears to be aligning in 2014 for adoption to grow and sustain (some) solid business models. On the demand side, Towers Watson’s 2014 survey of large employers forecasts growth among companies that will offer telemedicine in 2015. Towers found that 37% of employers planned to offer telemedicine to workers as a lower-cost site of care; 34% more employers were considering telemedicine in 2016 or 2017.  The health benefits adviser calculates that employers could save over $6 billion if industry replaces virtual health consultations with

“For Big Data, Big Questions Remain,” an article by Dawn Falk in the July 2014 issue of Health Affairs, captures the theme of the entire journal this month. That’s because, for every opportunity described in each expert’s view, there are also obstacles, challenges, and wild cards that impede the universal scaling of Big Data in the current U.S. healthcare and policy landscape. What is Big Data, anyway? It’s a moving target, Falk says: computing power is getting increasingly powerful (a la Moore’s Law), simpler and cheaper. At the same time, the amount of information applicable to health and health care

Consumers around the world are feeling more knowledgeable, self-confident and realistic, enabled by mobile platforms, the democratic power of social “choruses,” and a more sharing economy featuring collaborative consumption. As peoples’ phones get smarter and smarter, they carry more powerful multichannel information devices in their hands which empower Homo Informaticus – the new global digital consumer, described in EY’s report, How to copilot the multichannel journal. EY polled 29,943 consumers in the Consumers on Board survey living in 34 countries: across the Americas, Asia-Pacific, the Middle East, India and Africa. Homo informaticus is the rational consumer smartly using technology to filter information.

A vast majority of people shopping for a health plan on a Health Insurance Exchange for coverage in 2014 obtained information online via websites. One-half of these shoppers used only online information, and 29% combined both websites and other sources like direct assistance, informal assistance, and via (offline) media. In the Health Reform Monitoring Survey from the Urban Institute Health Policy Center, a research team, funded by the Robert Wood Johnson Foundation and the Ford Foundation, looked into data collected from the Health Reform Monitoring Survey in March 2014 at the end of the 2014 open enrollment period for the

When Mary Meeker talks, the digerati listen. Meeker is the digital industry analyst who’s a partner at KPCB, a venture capital company, in Silicon Valley. Each year she publishes a report on the state of the digital marketplace. Her 2014 paper, Internet Trends 2014 – Code Conference (dated May 28 2014)  is online, and as usual, it’s full of data points on both digital technology segments along with some vertical industry findings – in education, financial services, and health, among other segments. I’ve combed through the 164 pages of the PDF to trend-weave the health implications. When it comes to health, the

That’s a useful and timely question, given the news that Castlight Health will launch its IPO with valuations north of $1 billion. Yes, “billions,” and according to a  MarketWatch analysis, “it’s a bargain at $1 billion.” So then – do we anticipate a bubble? asked Marc Monseau of the Mint Collective, the convener of our panel who brought together Robert Stern, a successful health-tech entrepreneur whose latest venture, @PointofCare, focuses on patient engagement; Marco Smit of Next Innovation Health Partners (parting from the Health 2.0 Conference family where he led Health 2.0 Advisors for several years); and me. Some key

Today kicked off the 2014 South-by-Southwest Festival (#SXSW) in Austin, TX, running until March 16 and featuring dozens of sessions, concerts, video, and fireside chats in music, film and interactive segments. I’ll be involved in an interactive session on Tuesday called “The Digital Health Bubble – Is It About to Burst?” This panel includes Marc Monseau (@MDMonseau) who is a pioneer in health and social media (building J&J’s early leadership in social health online); Marco Smit (@MrHealth20) who leads Health 2.0 Advisors and is a veteran strategist in several health/tech companies; and, Robert Stern, Founder/CEO of @PointofCare, a health IT platform that

The convergence of technology developments – such as the internet, mobile phone adoption, cloud computing, sensors, electronic health records – with societal evolution including consumerism, demand for transparency, and “flatter” organizations – enable the phenomenon of Connected Health. Connected Health by definition includes mobile health (mHealth), telehealth and telemedicine, as presented in the February 2014 issue of Health Affairs which is dedicated to this theme. Why Connected Health’s time is Now relates to those factors cited above, and the underlying challenge of managing health care costs. While all nations in the developed world are facing difficult health economies, the U.S. spends so

  More than twice as many people value the opinions of friends and family for health care provider choices than turn to online ratings for doctors’ bedside manner, waiting times, or clinical quality, according to the Altarum Institute Survey of Consumer Health Care Opinions, Fall 2013, released on January 8, 2014. 1 in 3 consumers also looks into the cost and quality of services recommended by nurses, doctors, labs and hospitals before choosing a provider. However, most people (4 in 5) say they are comfortable asking their doctor about how much treatment will cost: 43% are “very comfortable,” and 38% somewhat comfortable,

While about 53% of people globally are willing to share various types of personal data overall, the kind of data willing-to-be-shared varies by type of information — and what country we’re from. When asked how likely they would be to anonymously share information if it could lead to improvements or innovations in that technology, Americans are less likely to be willing to share any type of personal data — except for gender. When it comes to sharing several specific types of health information, fewer Americans are likely to want to share it as Intel found in their survey published in the company’s Healthcare

Consumers embrace ongoing dialog with the companies they do business with, Varolii Corporation toplines in a survey report, What Do Customers Want? A Growing Appetite for Customer Communications. Across all vertical industries consumers trust for this dialogue, health care organizations – specifically doctors, pharmacists, and insurance companies – are the most trusted. Examples of “welcome-comms” would be reminders about upcoming appointments or vaccinations (among 69% of people), notices to reorder or pick up a prescription (57%), and messages encouraging scheduling an appointment (39%). In banking, notices about fraudulent activity on one’s account is the most welcomed message beating out appointment

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

Mobilising Healthcare, a new report from Juniper Research, segments the mobile health sector into “healthcare” and “health & fitness” segments. The research summary notes that fitness is a relatively new market compared with health “care,” which has been around for eons. Fitness, the analysts say, “is exempt from government intervention.” Mobile healthcare (“mHealth”) applications explored include SMS health messaging, remote health provision such as cardiac monitoring, electronic health records and personal health records. In mFitness, Juniper looks into mobile tech for athletes and fitness conscious people, and activity tracking including heart function, distance, respiration, and perspiration, among other parameters. mHealth

Since the advent of the so-called consumer-directed health care era in the mid-2000s, there’s been a love-gap between health plan members of traditional plans, living in Health Plan World 1.0, and people enrolled in newer consumer-driven plans – high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs). That gap in plan satisfaction continues, according to the Employee Benefits Research Institute (EBRI)’s poll of Americans’ consumer engagement in health care. The survey was conducted with the Commonwealth Fund. As the bar chart illustrates, some 62% of members in traditional plans were satisfied (very or extremely) with their health insurance in 2012.

Only 1 in 4 U.S. adults over 30 know what “personalized medicine” (PM) really is, and only 8% of people feel very knowledgeable about the concept based on Consumer Perspectives on Personalized Medicine from GfK, published online in August 2013. GfK surveyed 602 online adults 30 years and over between February and March 2013 drawn from the company’s KnowledgePanel sample of U.S. adults. Only 4% of people who have heard of personalized medicine describe it accurately as “medicine based on genome/genetic make up.” About one-half of people (52%) defined PM as medical care, treatment, or medicine geared toward individual needs. The poll

Imagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions? Welcome to the “health care automat,” the online healthcare marketplace. This is a separate concept from the new Health Insurance Marketplace, or Exchange. This emerging way to shop for and access health care services is explored in my latest paper for the California HealthCare Foundation (CHCF), Help Yourself: The Rise of Online Healthcare Marketplaces. What’s driving this new wrinkle in retail health care are: U.S. health citizens morphing into consumers,

  Most Americans are concerned about their ability to for medical bills, even when they have health insurance. As a result, most are comfortable asking their doctor about how much their medical treatment will cost. People are becoming savvier health care shoppers largely because they have to: 37% of people in the U.S. have an annual health insurance deductible over $2,000, according to the Spring/Summer 2013 Altarum Institute Survey of Consumer Health Care Opinion, published on 11th July 2013. Many of the media stories coming out of the Altarum survey since its publication have been about people and their trust in

The notion of consumers’ greater skin in the game of U.S. health care — and the underlying theory of rational economic men and women that would drive people to greater self-care — permeated the agenda of the 2nd annual Consumer Health & Wellness Innovation Summit, chaired by Lisa Suennen of Psilos Ventures. Lisa kicked off the meeting providing a wellness market landscape, describing the opportunity that is the ‘real’ consumer-driven health care: people getting and staying well, and increasing participation in self-management of chronic conditions. The U.S. health system is transforming, she explained, with payors beginning to look like computer

Tablets, wearables, smartphones, video and QR codes: these are fast-growing platforms moving data around the global economy. They’re also fast=growing platforms for health care where we live, work, play and pray. Mary Meeker’s annual presentation on Internet Trends at the D11 Conference, is fresh off the virtual press in its shiny new 2013 version. Meeker has been with the investment firm Kleiner Perkins Caulfield Byers (KPCB) since 2011, and was with Morgan Stanley from 1991 to 2010. She’s a veteran who’s watched the Internet basically from The Beginning. Of the 117 slides in her informative, gargantuan deck (a Meeker hallmark every

In this week’s BMJ (British Medical Journal), an American patient tells his story about being equipped, enabled, empowered and engaged — the many “e’s” making up the prefix of “ePatient.”  This definition comes out of the work of Dr. Tom Ferguson, who worked with the e-Patient Scholars Working Group in 2007, to publish the first white paper about the phenomenon, e-Patients: how they can help us heal health care. ePatient Dave is the patient-author of the BMJ piece, making the case for shared decision-making and patient involvement in health care decisions. He writes in the conclusion, “The value delivered by skilled

  Exploiting Big Data in industry is Big News these days, and nowhere is the potential for leveraging the concept greater than in health care. McKinsey & Company estimates that harnessing big data across five dimensions of health care could yield nearly one-half trillion dollars’ worth of value in The ‘big data’ revolution in healthcare. The chart summarizes McKinsey’s calculations on the value of Big Data in health care at its maximum. Before digging into the value potential, just what is Big Data in health care? Statistics and information are generated in the health care system about patients: say, during visits

While health care cost growth has slowed nationally, most Americans feel they’re going up faster than usual. 1 in 3 people believe their own health costs have gone up faster than usual, and 1 in 4 feel they’re going out about “the same amount” as usual. For only one-third, health costs feel like they’re staying even. As the second quarter of 2013 begins and the implementation of the Affordable Care Act (ACA, aka “health reform” and “Obamacare”) looms nearer, most Americans still don’t understand how the ACA will impact them. Most Americans (57%) believe the law will create a government-run health plan,

Digital health is attracting the likes of Bill Clinton, Lupe Fiasco, Deepak Chopra, Dr. Sanjay Gupta, Arianna Huffington, and numerous famous athletes who rep a growing array of activity trackers, wearable sensors, and mobile health apps. Will this diverse cadre of popular celebs drive consumer adoption of mobile health? Can a “cool factor” motivate people to try out mobile health tools that, over time, help people sustain healthy behaviors? Mobile and digital health is a fast-growing, good-news segment in the U.S. macroeconomy. The industry attracted more venture capital in 2012 than other health sectors, based on Rock Health’s analysis of the year-in-review. Digital health

Only one-third of U.S. physicians believe that patients should have “full access” to their electronic health records, according to Patient Access to Electronic Health Records What Does the Doctor Order?, a survey conducted by Accenture, released at HIMSS13 in March 2013. Two-thirds of doctors in the U.S. are open to patients having “limited access” to their EHRs. However, the extent to which doctors believe in full EHR access for patients depends on the type of health information contained in the record. Accenture surveyed 3,700 physicians in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States, and found the doctors’

I endured what very few people could (or would) do in the past ten days: I traveled to New Orleans to the annual conference of HIMSS, the Health Information Management Systems Society, which features hundreds of suppliers to the health care information technology industry. I returned home to kiss my family hello and goodbye, and a day later flew to Austin for the annual South-by-Southwest conference for music, movie and digital folks. The health track at SXSW has grown over the past five years, and provides a start contrast to “health care” as embodied at HIMSS, and “health” translated through

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

At HIMSS13 there are the equivalent of rock stars. Some of these are health system CIOs and health IT gurus who are driving significant and positive changes in their organizations, like Blackford Middleton, Keith Boone, Brian Ahier, and John Halamka. Others are C-level execs at health IT companies. In this latter group, many avoid the paparazzi (read: health trade reporters) and stay cocooned behind closed doors in two-story pieces of posh real estate on the exhibition floor. A few walk the floor, shake hands with folks, and take in the vibe of the event. We’ll call them open-source personalities. The

Traditional venture capital in health care is so 2010: welcome to The Greenhouse Effect: How Accelerators Are Seeding Digital Health Innovation, explained in a new report from California HealthCare Foundation written by Aaron Apodaca. Aaron clearly explains the growing interest in and influence of health accelerators, which grew out of the first era of the Internet (read: dot-com bust v 1.0) and the founding of the Y Combinator, an internet incubator that made relatively small investments in exchange for equity positions in start-ups. Health accelerators emerged around 2011, first with Rock Health in San Francisco, which was quickly followed by

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

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

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

PwC has seen the future of health care for the next year, and the crystal ball expects to see the following: Affordable Care Act implementation, with states playing lead roles The role of dual eligibles Employer’s role in health care benefits Consumers’ role in coverage Consumers’ ratings impact on health care Transforming health delivery Population health management Bring your own device Pharma’s changing value proposition The medical device industry & tax impact. In their report, Top health industry issues of 2013: picking up the pace on health reform, PwC summarizes these expectations as a “future [that] includes full implementation of

1 in 3 U.S. adults have enough trust in online health resources that they’ve gone online to diagnose a condition for themselves or a friend. “For one-third of U.S. adults, the Internet is a diagnostic tool,” according to Health Online, the latest survey on online health from the Pew Internet & American Life Project. Nearly one-half of these people eventually sought medical attention. One-third did not. Women are more likely to do online medical diagnoses than men do, as do more affluent, college-educated people. When people perceive they’re ‘really’ sick, 70% get information and care from a health professional and

Over one-third of U.S. consumers plan to buy a new fitness technology in the next year, especially women. They’ll buy these at mass merchants (females in particular, shopping at Target and Walmart), sporting goods retailers (more male buyers here), online and at electronics stores like Best Buy. These potential buyers consider themselves in good or excellent physical health. They’ll see the latest applications on retail store shelves in pedometers, calorie trackers, fitness video games, digital weight scales, and heart rate monitors that will be launched this week at the 2013 Consumer Electronics Show in Las Vegas. In advance of the

  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

Notwithstanding the fact that most phones on U.S. streets are “smart” ones, most adults surf the net for health information, and most people try to change a health habit each year, Americans haven’t adopted healthier long-term relationships with food. The International Food Information Council has conducted the Food & Health Survey: Consumer Attitudes Toward Food, Safety, Nutrition & Health poll since 2006, thus enabling us to track peoples’ attitudes and behaviors over the past several years. The latest polling results appear in Is it Time to Rethink Nutrition Communications? A 5-Year Retrospective of Americans’ Attitude toward Food, Nutrition, and Health online in

The ubiquity of mobile phones, increasingly smart ones (one-half of all mobile phones in the U.S. ), means people are walking around, working, playing and driving with self-tracking devices and ultra-mini computers in their pockets and totebags. 52% of smartphone owners seek health information on their phones, and overall 1 in 3 people seek health information on all mobile phones — nearly doubling the percent of those seeking health info via mobile in 2010 (17%). People who are sicker, caregivers, and those who have had a big change in health are also more prone to using phones for health, as

Wired magazine, longtime evangelist for all-things-tech, has played a growing role in serving up health-tech content over the past several years, especially through the work of Thomas Goetz. This month, Wired featured an informative section on living by numbers — the theme of a new Wired conference held 15-16 October 2012 in New York City. This feels like the week of digital health on the east coast of the U.S.: several major meetings have convened that highlight the role of technology — especially, the Internet, mobile platforms, and Big Data — on health. Among the meetings were the NYeC Digital Health conference, Digital

The first day of the Health 2.0 Conference in San Francisco kicked off with a video illustrating the global reach of the Health 2.0 concept, from NY and Boston to Mumbai, Madrid, London, Tokyo and other points abroad. Technology is making the health world flatter and smarter…and sometimes, increasing problematic fragmentation, which is a theme that kept pinching me through the first day’s discussions and demonstrations. Joe Flowers, health futurist, offered a cogent, crisp forecast in the morning, noting that health care is changing, undergoing fundamental economic changes that change everything about it. These are driving us to what may

Transparency in health care can bring greater empowerment and enable more rational decision making for health consumers. Physicians acknowledge this: “We believe that increasing transparency in the health care system can be beneficial to both patients and physicians,” said J. Fred Raslton, Jr., MD, FACP, president of the American College of Physicians. There’s an indication that patients will embrace transparency in the form of accessing their physicians’ notes about them, based on the OpenNotes project research published in the Annals of Internal Medicine this week. The objective of the study was to measure the impact on doctors and patients of extending

Patients are morphing into health care consumers with growing use of technology for medical shopping and health engagement, according to a survey conducted by Altarum, the health services research organization. Virtually all (99%) of U.S. health citizens want to play a role in medical decisions about their care. However, consumers vary in just how much of that responsibility they want to assume: – 35% want to make the final decision with some input from doctors and other experts – 29% want to be completely in charge of their decisions – 28% want to make a joint decision with equal input

As women are generally thought of by marketers as the Chief Health Officers of their families, images of men in health advertising and media have been fewer than their female counterparts. In 1998, Pfizer promoted Viagra through Bob Dole. In 2003, Magic Johnson represented GSK’s HIV treatment Combivir. That same year, Mike Ditka, football coach, hawked Levitra, the ED drug, for GSK. Dr. Robert Jarvik has repped Lipitor (controversially), and Bobby Labonte, a NASCAR driver, endorsed Wellbutrin XL. But since the advent of direct-to-consumer health advertising, there haven’t been as many celebrity men promoting health as there have been women. Now, it’s the

While 87% of U.S. adults are familiar with health providers converting paper medical records into digital records, only 26% — 1 in 4 — say they want their own medical records to go digital. This sobering statistic comes as hundreds of thousands of doctors and hospitals are migrating to electronic health records (EHRs), motivated by the U.S. government’s HITECH act which provides incentives for the adoption and so-called meaningful use of EHRs. To gauge U.S. consumers’ views on digital medical records, Xerox polled 2,147 U.S. adults ages 18 and via an online survey in May 2012. The chart illustrates several key

Over one-half of office-based physicians in the U.S. had adopted an electronic health record (EHR) in 2011. Among theese adopters, 85% were satisfied: 38% “very,” and 47% “somewhat.” Those are pretty good reviews considering so many came to EHRs based on the government’s HITECH incentive and not motivated purely out of intrinsic personal passion to adopt digital medical records systems. This update comes from the July 2012 Data Brief from the National Center for Health Statistic, Physician Adoption of Electronic Health Records Systems: United States. 2011. The report details survey findings from 5,232 office-based physicians who completed the mailed questionnaire in

Using social networks for health is no longer a pioneering, first-wave adoption activity: Facebook has gone mainstream in health. What’s the indicator that says we’ve hit the tipping point in consumers going Health 2,0, beyond Paging Doctor Google? A story in the July 2012 issue of Good Housekeeping magazine titled, Miracle on Facebook. What’s powerful about this is that articles on health social networks have been largely focused in health IT trade publications, business magazines like Forbes  (focusing on sustainbale business modeels) and technology channels such as Fast Company and Wired. Looking at Good Housekeeping’s ad pages, its readership is mostly

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