Findings Of the 398 patients that have been screened so far: No new information was provided by the screen.... 103 The new information was determined to be a lab error or an artifact.. The new information and abnormalities were considered to be insignificant. 81 The new abnormalities required no treatment- The new abnormalities were significant and required follow-up--- The abnormalities had obscure significance_ The information was erroneous.... Additional diagnosis of diabetes mellitus.. Additional diagnosis of uremia__ Diagnosis changed from splenomegaly to polycystic kidneys. 29 4 1 Plans for routine laboratory studies at the University of Minnesota hospitals Expanded or deleted as indicated by clinical judgment and economic considerations. It does not include, at present, tests such as motor performance, which would be selected on the basis of age and sex for pediatric patients. 2 Bicarbonate and chloride if Na or K is abnormal. LDH isoenzyme separation if LDH is abnormal. MAURINE B. NEUBERGER, UNIVERSITY OF MISSOURI, MEDICAL CENTER, Columbia, September 12, 1966. Chairman, Subcommittee on Health of the Elderly U.S. Senate, Washington, D.C. DEAR SENATOR NEUBERGER: Following receipt of your recent letter, Dr. Wilson has had an opportunity to discuss multiphasic screening with me and asked that I compose an answer to your letter. There are several members of our faculty who have either past or current experience with multiphasic screening programs or participated in a more specific type of screening program. In addition, there are members of our faculty who are engaged in research activities which have a bearing on conduction of multiphasic health screening programs. Therefore, I will attempt to give a composite answer to the questions you ask. First, a word in general in regard to multiphasic screening. We feel it is important to remember that this is screening and not necessarily diagnostic and that multiphasic screening can be an important tool in the hands of the physician to arrive at a diagnosis but it does not replace the history and the physical examination. In answer to your question "Is there a place for multiphasic health screening in health care in our country?" we feel that the answer is definitely yes to this question but how effective and productive this will be will depend on how it is introduced, the understanding, both on the professional and the lay level and of reaching that plateau where laboratory data is wholly reliable and accurate. From our past experience, for multiphasic screening to be acceptable to the public at large and to the medical profession and at the same time be most productive, it must be made available at the local level inasmuch as it is possible to do so. This may mean that we need to develop models whereby an automated basic screening could be done in each physician's office. This basic battery of screening tests might give the indication of whether the individual should go to his local community hospital for a more complex and sophisticated level of screening, and this battery of tests might indicate that the individual should go to a larger medical center where an even more complicated battery of screening tests would be given in addition to specialized testing. In our personal experience with screening programs we feel that for it to be effective and reach as high a percent of the population of a particular area, it must have the complete understanding and acceptance, not only by the public but by the medical profession in that particular area, and that they must be given an opportunity to actively participate and be a part of the program if it is to be acceptable. In addition to the above we need to make an accurate determination of which tests should be included in each level of screening for this to be most effective at the least cost to the patient. In answering question 2, rather than attempt to list all of the faculty members and brief descriptions of all the programs various ones have been involved in, I will briefly list the departments and heads of the departments: Department of Community Health and Medical Practice, H. M. Parrish, M.D. Department of Pathology, Fred V. Lucas, M.D. Department of Pediatrics, Robert L. Jackson, M.D. Department of Surgery, Section of Ophthalmogy, John A. Members of the above-named departments have had varying experience with specific screening programs, and a few have had experience in multiphasic screening programs. In addition, experimentation and research with automated screening, standardization of tests, and computerization of data and models of stages of screening are under way. In answer to question 3, while many conditions, particularly chronic illnesses, are more apparent in individuals above the age of 60, many of these conditions started years before, even in childhood. Therefore, properly developed and with a measure of selectivity, it would seem appropriate for any screening program to be used at a time when it would be most apt to pick up the condition at its earliest beginning if we would hope to be effective in primary prevention. It would seem important to realize that at the present time there are a number of problems before mass population screening can become a reality. One, of course, is adequate reference standards. These are yet to be developed although there is work in this area at the present time. However, quite frankly, such reference standards are either not available for a number of tests or if they are available, are often of poor quality. Another problem which should be mentioned is that of development of appropriate methods for sampling, the preservation, preparation, and transportation of biological materials in a standardized format. Another problem of which we are aware of and have been doing some work on, is what are the normal ranges which must be established by age range, sex, and race differences as well as other genetic variations. For instance, does screening for diabetes done by blood sugar method or a modified glucose tolerance test have varying levels of normal depending on the race, age, and sex of the individual? A fourth problem would seem to be one which is quite important and that is manpower. At the present moment there is a serious shortage of qualified individuals capable of staffing laboratories to handle such volumes of multiphasic screening and in addition, there is a need for additional training programs for both the professional and technical personnel. I realize this is a rather brief report, however I will be happy to go into greater detail if there are any additional specific questions or aspects that you feel you would like to have us comment on. In summary, we feel that multiphasic screening does have a real place in the practice of medicine particularly as we stride further into the realm of the practice of preventive medicine, and hopefully wherever possible, this would be primary prevention. We realize that there are many problems yet to be solved before this can be most effective |