Dr. John Bartlett, The Carter Center Mental Health Project

(Music)

Mark Masselli : This is conversation on Healthc are. I ’m Mark Masselli .

Margret Flinter: And I am Margret Flinter .

Mark Masselli : Well Margret here we are on the brink of the largest roll out of a social
program in 50 years in this country . T he Affordable Care Ac t and even supporters of
ObamaCare warn there maybe glitches to work out before the system gets fully
operational or maybe I should say systems.

Margret Flinter: Well it is a b it daunting Mark to think about h ow much infrastructure
h ad to be put in place in the few short years since the law first was signed into
Legislation in 2010 and since was upheld by the Supreme Court last year really it was a
h erculean task.

Mark Masselli : Well we ’re going to keep an eye on what's happening in congress but
for now economist from the nation’s largest teaching institutions to think tanks like The
Brookings I nstitution are warning that the f ield is right for lo ads of errors to happen and
they will . We also have different infrastructure s in each s tate and the federal health
exchange is going to have to function in 33 differe nt states. I think you chose the word
right Margret it ’ s daunting .

Margret Flinter: Well d aunting but I must say that I’m reminded of the implementation of
Medicare party in the pharmacy benefit for seniors with all of the technology changes
and new learning that senior s had to do to sign up and it was daunting and pretty
successful . So I’m going to remain and optimist. And, Mark , as you know many states
across the nation ha ve been dealing with one of their princip le challenges being
antiquated d ata infrastructure s that in some cases are quite old, the data requirement s
for the Affordable Care Act of course require much more modern integrated systems
and actually that's a goo d thing for health data analytics moving forward.

Mark Masselli : But you know there's one area in health care in particular where
gathering better data would be helpful and we have a meaningful impact on improved
health outcomes. It’s believe that four o ut of 10 person seeking help in an emergency
room or even at a doctor’s office has it undiagnosed behavior al health or substance
abuse issue , it’s something our guest today know s quite a bit about.

Margret Flinter: Dr. John Bartlett is Senior Project Adv isor for the Primary Care Initiative
at the Carter Center w hich is seeking to embed behavior al health screening and
treatment right in the primary care setting. This is all part of form er President Jimmy
Carter and First Lady Rosalynn Carter’s efforts to improve mental health in this country
issue that effect so much o f our population.

Mark Masselli : W e ll also here from the Fac tcheck .org’s Managing Editor Lor í
Robertson.

Margret Flinter: Lor i is always ferreting out misstatement s about health policy th at are
in the public d omain but no matter what the topic you can hear all our shows by going to
CHC R adio.

Mark Masselli : And a s always if you have comments please email us at chcradio.com
or find as o n Facebook or Twitter because we ’d love to hear from you.

Margret Flinter: Now we’ll get to our interview with Dr. John Bartlett in just a moment.

Mark Masselli : But first here’s our producer Marianne O'Hare with these weeks
Headline News .

(Music )

Marianne O'Hare : I’m Marianne O'Hare with theses Healt hcare Headlines . The
Health c are Law is launching into the next phase of implementation and its happening
with something of a bang not a whimper, political wrangling continues in Washington
where the re are a hold outside T e x a s S enator Ted Cruz incurring ra sh from both sides
of the isle for threatening t o Filibuster a vote on any bill to finance the US Government
that has funding attach to it for the Health c are Law . The fiscal year begins October 1st
and without a continuing resolution government would shut down.

Meanwhile confusion reign supreme in many parts of the country on requirement s for
the insurance exchanges how they will operate, who should be shopping for health
insurance on those o nline insurance marketplaces. And s tates like Missouri which has
800,000 uninsured residen ts ha lf of whom would qualif y for subsidies by purchasing
health insurance on the exchanges. The Lieutenant Governor has spoken publically
there urging residen ts , not to seek insurance on the exchanges saying he would hope
the La w would f ail .

Meanwhile in Louisiana one of the states with the highest level of uninsured residen ts
the insurance commission er there has said the insurance exchanges are just too
confusing for people to understand . Louisiana is also relying on the Feder al Exchange .

Meanwhile in s tates like California and Connecticut which are setting up exchanges of
their own and are testing them for readiness officials and t hose states are urging fo lks
seeking insurance on the exchanges to reach out for help, from the health de partment s
in those states and other entities being trained to help navigate your online insurance
marketplaces . Access Health CT and covered California have been working to setup
exchanges for several years as insurance commissioners in New York S tate and others.

President Obama is getting a little help this week from Former President Clinton,
holding a join t meeting in New York to discuss the merits of the Health c are L a w .
President Clinton made a n uns uccessful bi d to pass health reform during h is 10 year in

the 90s . H e is now acting as a n Ambassador for the Health c are L a w for President
Obama.

Meanwhile t he Health c are L a w is forcing a lot of companies to rethink their heal th
insurance strategies especially when it come s to retir ees , spouses and former
employees continuing to be covered under COBRA . Health Law provision i s taking
effect next year , couldn’t save US employers b illions of dollars in expenses now paid for
workers, who continue medical coverage after they leave the company. 41 % of l arge
business is recently surveyed b y the National Business Group on Health expect former
employees eligible for COBRA to seek coverage next year on the exchanges instead.
Analyst expect few ex - employees if any will chose COBRA once the online
mark et pla ce s are available, not only will the rate s be cheaper on the exchanges th ey
won’t be denied coverage due to pre - existing conditions and they’ll be able to take
advantage of the tax subsidies.

From the medical grounds , the National Institute of Health is stu dying a drug , they say
it’s being explored for its potential to prevent the onset of Alzheimer’s in patients
carr ying the gene that increases s us ceptibility to the dementia dis ord er, they currently
afflicts 4 million people in this country. That number is expected to increase
dramatically as the nation ’ s population continues to age . Currently , there are very few
drugs that combat progression of the disease and we are far from a cure.

And it’s time if you haven’t tell your kids not to smoke when it was a well - known fact that
the President is a smoker or was President Obama was heard over a hot m icrophone in
a recent public event , explaining what made him quit. H e said he was afraid of his wife.
Well Sir, whatever gets the job done.

I'm Maria nne O’Hare , with th ese Health c are Headlines.

(Music)

Mark Masselli : We ’re speaking today with Dr. John Bartlett , Senior Project Director for
the Primary Care Initiative at the Carter Centers Mental Health Program. The Carter
Center , founded 30 years ago by former President Jimmy Carter and former F irst Lady
Rosalynn Carter , is as non - profit organization dedicated to promoting peace and better
health throughout th e world. Dr . Bartlett coo rdinates the activities of the Primary Care
I nitiative which seek s to facilita te better treatment of mental health and substance a buse
in the p ri mary care setting. Dr . Bartlett earned his m edical d egree from Yale , and
com pleted his psychiatry residency at UCLA M edical Center. He’s a former Vice
President for Cigna Mental Health an d is at Robert W ood Johnson Clinical S cholar . Dr
Bartlett, w elcome to conversations on Health care.

Dr. John Bartlett: Thank you so much , Mark. Thanks for the opportunity.

Mark Masselli : John, you’ ve logged a few decades in the area of behavioral h eal th and
substance abuse and it ’s estimated that six ou t of 10 Americans visiting a primary c are

provider suffering from some sort of b ehavioral health or a ddiction issue. But that often
th ose issues do not get recognized , or adequately addressed in the p ri mary care
setting . So, how much of an effect is this really having on people’s health care in this
country?

Dr. John Bartlett: That’s an excellent question Mark . A nd frankly one that gets right to
the heart of what we see a s the opportunity here. State of the a rt epidemiological
st udies , I mean studies that look at the incidents and prevalence of diseases in a
population show that in any given year in this country about 25 % of the general
population meet current diagnostic criteria for mental health or s ubstance a bus e issue .
Now, that doesn’t mean that they’re all diagnosed, it cer tainly doesn’t mean that they
ge t treated. But they do meet diagnostic criteria. So , we know that issues like
depressions and anxiety and addiction are widespread on the gen eral pop ulation. We
also know that these conditions were associated with high levels of both morbidity and
disability. In fact, in the developed world, countries like the United States, Canada,
Western Europe, depression is the leading cause of disabilit y adjusted life years, in
other words it carries the greatest burden of disease, far greater than something like
heart disease. They’re prevale nt, they cause a lot disability , a lot of morbidity , and most
importantly in the context to what’s going on in t his country right now with our
tremendous budgetary and financial issues, there’s a tremendous amount of expense
associated with the co - occurrence of a chronic medical condition like heart disease or
diabetes, and depression or anxiety.

In the debates aro und the Affordable Care Act that show ed that up to 15 , and even 20 %
of cause associated with chronic medical c onditions could be directly related to co -
morbid mental Illness and o r substance a buse. If you throw in behavioral issues like
lifestyle choices , smoking, lack of exercise, obesity, you start to see the scope of the
issue and in fact, cur rent studies from a major leading M ana ge Care C ompanies show
that about six in 10 patients who show up in the primary care, d octors have some
behavioral component, either a condition like depression or anxiety or a lifestyle
problem as part of their presentation. So, it’s really a huge issue.

Margaret Flinter: So, Jo hn tell us more about the Primary C are I nitiative itself at the
Carters C ent er s Mental Health prog ram, how is this initiative moving us forward in
ameliorating this problem of lack of access to mental health and addiction services and
let me add the word affective to that as well lack of excess to affective mental health
and addiction services.

Dr. Jo hn Bartlett: Traditionally the focus of mental health and addiction policy has been
on those most severely impacted people , what’s called severe and persistent mental
illness. People who are you know, addicted and need abstinence - based treatment
etcetera . And that has really been a tremendous focus for the last 30 years or so and
frankly a successful because we had things like the institution of parity with the Mental
Health and Addiction Parity Act. But beginning with the release of David Satcher, when
he was the surgeon general he released a report on mental health in America in 1999,
and that really started a growing recognition that there was a hidden crisis about

accessing appropriate and effective mental healthcare. And when I say hidden it was --
it occurred to people who were seeing doctors, they weren’t seeing specialist, they were
seeing primary care doctors or general medical doctors or medical specialist whatever.
So that report really highlighted this there is a large associated behavioral component to
the presentation of many, many people , depression problem, drinking or drugging and
unhealthy lifestyle choice, etcetera. A lot of the work has been done in the area of
depression for obviously reasons, it’s an important condition it’s one th at we have
treatments for and treatments frankly that can be implemented in the primary care
sector.

Over 50 % of the people who get treated for depression received their treatment only in
the primary care center. Under routine approaches to these patient s, only 30% show
clinically significant improvement. Yet at the same time for many of the past several
years anti - depression medications have been among the most widely prescribed ,
classes of medication in the country in 2005 in fact , t hey were the most w idely
prescribed class of medication . S o what we have is we have a tremendous amount of
time, energy, money going into the treatment of the condition like depression and yet
only a very low clinically significant response rate. So we are literally wastin g tens of
millions of dollars are not ineffective treatments but ineffective courses of treatment.
The medications have all gone through FDA reviewed but it’s how they are being
prescribed, how they are being followed, that is not going on in the primary care setting,
not because primary care doctors are bad people, they are busy people.

The average primary care visit last summer between 12 and 15 minutes, in that 12 to 15
minutes a primary care doctor has to deal with three or four chronic medical issues as
well as a depression , anxiety , problem drinking, drugging etc etera . So depression sort
of comes usually at the end, how is your sleep, are you feeling better ? Yes , etcetera.
It's not adequate follow up and so in fact what we find is that response ra tes are not
very good in the primary care setting. We really have a lot of work to do in terms of
becoming more scientific about how we not just prescribe medication s but more
importantly how we follow treatment response.

Mark Masselli: John you’ve got great perch at the Carter Center where you work with
multiple partners in the pursuit of eradicating disease globally but also providing better
healthcare to American ’ s here at home and wonder if the conversation that you are just
having now came out of th e work that you done at the health education summit where
you jointly held the summit with the American College of Physicians and issued a paper
the five prescriptions for ensuring the future of primary care. So, perhaps you were
telling us part of that a lready or if not can you tell us about the both the collaboration
with a College of Physicians and what are you prescribing for the primary care
practices?

Dr. John Bartlett: Well we have a very active and collaborative relationship with the
primary care specialties, the American College of Physicians, the American Academy of
Family Physicians, etcetera.

And actually what I was talking about did lead to the health educations summit market
actually came out of an earlier summit meeting that we had here ca lled the Medical
Home Summit, which happened in the summer of 2009 and that summit we brought
together about 50 people from the fields of primary care, behavioral care. So the
question that we try to address at the medical home summit was could the patien t
centered medical home be used as a platform to scale up evidence based approaches
to integrated care ? Out of that meeting came a couple of recommendations. One was
that we work closely with the crediting organizations like the National Committee on
Qua lity Insurance to make sure that whatever standards were developed for crediting
patients in a medical homes focused very clearly and explicitly on the importance of
recognizing, screening and addressing behavioral health issues in the primary care and
tha t was an effort that was successful with the release of the new revised standards for
the patient center medical home about a year and half ago.

The other thing that was recommendation that came out of the medical home summit
was that we do something to a ddress the education of health professions that led to the
health education summit which we co - sponsored with the American College of
Physicians. At that summit, we tried to address the question of are we training the
health profession students of today t o work efficiently and effectively in the health
delivery system of tomorrow.

Margaret Flinter: Well John, we look at this pipeline; where is this workforce coming
from and as we look at the early implementation of elements of the Affordable Care Act
and then more of it coming in January 2014, how is the Affordable Care Act speaking to
the issue of workforce size and development, education and training?

Dr. John Bartlett: In the context of integrated care Margaret, it’s doing some things well .
I mean it certainly has made a commitment to increase the size and impact of the
primary c are workforce in this country. Okay, s o there are provisions within the
Affordable Care Act that increase reimbursement to primary care physicians which have
traditionally be e n underfunded like psychiatrist and other mental health clinicians have
traditionally been underfunded .

In terms of promoting integrated care, it’s exactly those initiatives that you just spoke
about; the Patient Centered Medical Home demonstration proje cts and the Accountable
Care Organization demonstration projects that really are advancing integrated care as
well . I mean, it’s my belief that when you start moving into an environment like an
Accountable Care Organization where a single entity is respon sible for both the clinical
and the financial results, if you do not aggressively screen for and address behavioral
health issues like depression and problem drinking, drugging , you’ll never be able to
meet the financial or clinical goals . So, that’s real ly the next generation of hope for
integrated care in a way .

In terms of producing a workforce that is trained to work in that direction, there is still a
lot that needs to be done frankly . I mean t here is a great emphasis now on teaching
team based work to health profession students , but in terms of focusing that on the role

of the behavioral specialist within the team and the recognition on the part of primary
care providers that behavioral health issues are a major part of what they are going to
be see ing in their primary care practice . There is still a lot of work that needs to be
done.

Mark Masselli: We’re speaking today with Dr . John Bartlett, Senior Project Director for
the Primary Care Initiative at the Carter Center’s Mental Health Program whic h is
seeking to train primary care clinicians to better identify and treat behavioral health and
addiction issues in the primary care setting . Now , the Carter Center relies a lot on the
idea of team work to achieve its goals and its work pretty well for t he organization, but
you say that teaching teamwork is an essential element of medical training of the future .
Explain to us how you see teamwork model evolving in the emerging area of medicine.

Dr. John Bartlett: I think that th at primary care is a tea m based sport, frankly . People
come in with incredibly complex presentations and because of the current emphasis on
efficiency in the primary care setting, the care of individuals happen in a team based
environment . In 12 to 15 minutes, no single individ ual can address appropriately all of
the issues that people bring into a primary care visit . It doesn’t mean they have to do it
all themselves , but it does mean that in a comprehensive integrated effective primary
care environment all of the services need to be provided and you can only do that
through a team based approach .

Now, the interesting thing; I actually -- you pointed it out earlier that I spent a number of
years as a Senior Vice President Corporate Medical Director for Cigna Behavioral
Health C are , I worked in industry with companies like General Electric and Martin
Marietta and IBM, and the amount of money and resources that corporate America puts
into training teams to be high functioning teams is huge, it’s literally tens of millions of
dolla rs . We put no money into that in healthcare . When I graduated from my residency
-- oh, excuse me, my internship; I was a medical intern at Jefferson University in
Philadelphia, I got in my car, I drove to California where two weeks later , I was the
leade r of a treatment team at UCLA . I knew nothing more about psychiatry than I had
two weeks ago when I was a medical intern , b ut I was the team leader . So, we don’t do
a very good job of training people to be more effective team members . We need to pay
att ention to them .

Margaret Flinter: I want to maybe move one degree away from what we think of as a
classic primary care office and think about innovation; maybe one step we move still
within but what we would think of as a general domains of primary care and ask you to
comment on your work in this area, you ’ r e thinking about how it contributes, and I’m
thinking specifically of things like a school based health centers.

Dr. John Bartlett: One of the interesting things that we ’re doing here is that we’ve
a ctually sort of moved the concept of integration beyond the context of integrating
primary care and behavioral care. We are actually moving into integrating the medical
and behavioral delivery system into the greater community.

One of the things that I a m involved now is working with Safe Base d C ommunit ies
around the country to move behavioral health screening out of the healthcare
environment into the Safe Base d environment through pastoral screening and
counseling frankly. A couple of years ago, we co - facilitated a meeting with the National
Center for Primary Care at Morehouse School of M edicine where we brought together a
group of individuals from organizations such as yours who have moved pretty far down
the path towards being patient center ed medical homes. And then we invited a whole
bunch of other people who are interested but had not made that commitment yet, and it
was funny. All the people who would sit there and say like, we ll we’ re really interest it in
this but we need to get paid for it. A ll the elderly doctors said don’t worry about that, it
will more than pay for itself, it’s the right thing to do.

Interestingly enough, when you start moving this into the pastoral environment, they just
focused on that, it’s the right thing to do. And s o we are very interested in using this
mobilization of the Safe Base d C ommunity, we could just as easily look at mobilizing the
business community as you talked about. It’s using th e s e other channels to bring
screening and early intervention s out into the community in an effort to improve overall
community health that we are getting very interested at this point.

Mark Masselli: We have been speaking today with Dr . John Bartlett, Senior Project
Director for the Primary Care Initiative at the Carter Center s Mental Health Program.
The Carter Center founded 30 years ago by former President Jimmy Carter and First
Lady Rosalynn Carter, you can learn more about all of the exciting work that’s been
done at the center by going to cartercenter.org . Dr.Bartlett , t hank you so much for
joining us today on conversation s on healthcare.

Dr. John Bartlett: Thank you so much Mark and Margaret.

(Music )

Mark Masselli: At Conversations on Health c are we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy . Lori Robertson is
an award - winning journalist and managing editor of factcheck.org , non - partisan, non -
profit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori, what have you g ot for you this week ?

Lori Robertson: Well, over the year we ’ ve de bunk to claim that C ongress was exempt
from the Affordable Care Act . It wasn’t through 2010 when the law was being debated
and it’s not true now either. Congress isn’t exempt from the la w’s requirement to have
insurance or pay a penalty if you don’t, in fact if the law places in additional and unusual
requirement on numbers of C ongress and their staff. It says that members and staff
first must get their insurance through the exchanges cr eated by the law starting in 2014.
They can’t get insurance like they do now or like other federal employee s through the
federal employees health benefits program.

This provision was added by a Republican Amendment with the idea that if the
exchanges wer e good enough for other American they should be good enough for
Congress . There is a problem though the provision doesn’t say anything about the
Federal Government being able to continue to contribute to premium of staffers and
lawmakers just as many empl oyers do for their workers.

In August, the office of personal management which administers the federal employees’
health benefits program issued a proposed rule saying that the government would be
able to continue to make those premium contribution s and t he contribution s couldn’t be
greater than what the government provides under the health benefit program for other
federal employee’s.

That prompted new claims with C ongress been exempt from the law or getting a special
subsidy. But this opposed it specia l subsidy is simply the premium contribution that
C ongress as employer the Federal Government has long made to the health plans of its
employees . A nd that’s my FactCheck for this week . I am Lori Robertson Managing
Editor of FactCheck.org.

Margaret Flint er: FactCheck.org is committed to factual accuracy from the countries
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you’d like checked, email us at
chcradio.com, we will have FactCheck.org Lori Robertson check it out for you here in
our C onversation on Healthcare.

(Music)

Mark Masselli: Each week conversation highlights a bright idea about how to make
wellness apart of our communities in everyday lives.

Its new secret that the nation’s kids are sedentary and overweight and the problem isn’t
been remediate in many of the nations elementary in middle schools where there is little
or no structured physical education. The National Foundation on Fitness Sports and
N utrition has partnered with other organizations to find tools that will improve the
physical health of students in schools across America. There is a new Fizz Ed partner
in town enter a popular interactive videogame, “dance - dance revolution”, a game that
engages players in real physical activity with energetic music and visuals on a computer
monitor to keep participants moving for sustain periods.

Rich K illingsworth : Dance is one of the things that resonates with children and
economy has really advance d two components here , using a gaming contexts and
promoting more physical activity through either a physical education program or through
recess time also those break period s where children can ac cess to set school or other
youth serving organizations.

Mar k Masselli: Rich K illingsworth is the Foundation ’s Former Director and says they are
congressionally chartered mission was to create private sector partnerships that will
enable all American ’ s and especially American c hildren to lea d healthier lives.

Ric h K illingsworth : So we’re looking at where children and others are spending their
time and when you think about how we spen t our time during the day six to eight hours
of day is spent behind a screen whether that’s a computer screen or a TV screen using
t hat moment and for children to create more activity and something that resonates with
them, gaming is a powerful tool, it’s a social tool and if we can build and wage for them
to be active t hrough that it’s going to be sustainable and it’s going to resonat e with
them. They’re going to be attract ed to it and use it as part of their cultural way of
connecting.

Mark Massel l i: So, they for med a partnership DDR creator ’ s Konami to create dance -
dance revolution class room addition. The PC run program is user friendly led by a
teacher and each kid has a dance path that tracks the ir BMI, their calories burn ed and
the ir physical output during the sessions.

Rich K illingsworth : It is on a base line for where they are and then how they’re
improving and that cultur ally is very different from wh ere we were, kids are more
oriented to numbers now and how progress is important in their social network.

Mark Masselli: Killingworth says that the pilot programs in a number of schools have
been extremely promising. Kids a re already familiar with a game, have fun engag ing in
it and there’s a competitive element as well that’s spur s the kids on. The partnership
also includes the American Diabetes Association , the American Alliance for Health
Physical Education Recreation an d Dance , dance - dance revolution, class room addition.
A fun familiar fast pace videogame being used in the simple school setting to
significantly increase d daily movement and improve physical fitness. Now that’s a
bright idea.

(Music)

Ma rianne O’ H are: I'm Ma rianne O’Hare with this tech report.

So you ’ve got a condition that requires constant monitoring of your blood properties or
sugar levels, the best way to keep a handle on what the vitals look like is to pick the
skin, collect the sample and summit for analysis, right? Well, scientists at the École
Polytechnique Fédérale in Lausanne Switzerland have cooked up a neat alternative, a
tiny portable personal blood testing laboratory about a half inch long, a device that’s
implanted just under the skin th at can o ffer immediate analysis of substances in the
body.

Dr. Giovanni : The chip is placed in interstitial tissue and it c omes in contact with fluids
in the body, and the sensor s react to the presen ce of particular compounds detect them
and then sen t th e measurement s outside.

Marianne O’Hare: Well Giovanni De Micheli says it has all kinds of applications for folks
with chronic health conditions. It can detect the presen ce of enzymes warning of an
imminent heart attack or glucose levels that could indi cate a diabetic cris is is looming.

Dr Giovanni: The chip is really a nano system . There are pops built with nano
technology that can sense compounds in the blood and then there is an electronic part
that processed th is information and transmit s outside the body.

Marianne O’Hare: Co - developer Sandro Carrara says the chip itself has no battery but
it’s powered by a patch place d on top of the skin where the chip rest that then has the
power to pick up all that data transmit it in real - time to a c linician in a remote setting.

Sandro Carrara : Then the patch transmits thanks to a B luetooth connection t he data to
a Smartphone or an iPod allowing telemedicine chain.

Marianne O’Hare: Bluetooth isn’t just for navigating on the roadways anymore ; it can be
used for all kinds of medical data navigation . The chips are expected to be especially
promising for patients undergoing chemot herapy for whom blood test must be
conducted to determine whether they can handle a certain dose. A device like this
could provide continual information about a patient ’ s t olerance levels. While the results
are promising, researchers expect the product won’t hit the marketplace for a couple of
years but for folks who have chronic conditions requiring constant blood analysis this is
s omething they would definitely appreciate having under their skin.

I'm Mar ianne O’Hare with this tech report.

(Music)

Margaret Flinter: This is Conversations on Health c are. I am Margaret Flinter .

Mark Masselli: And I am Mark Masselli peace and health.

Conversations on Health c are, broadcast from the Campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center .