and feel that this should not be limited to any particular age group if it is to be most productive from the patient's standpoint. Sincerely, W. C. ALLEN, M.D., Assistant Medical Director. THE UNIVERSITY OF NORTH CAROLINA, Hon. MAURINE B. NEUBERGER, U.S. Senate, Washington, D.C. OFFICE OF THE DEAN, Chapel Hill, September 9, 1966. DEAR SENATOR NEUBERGER: Dr. William L. Fleming, assistant dean in this medical school and chairman of our department of preventive medicine, has answered for me your letter of August 23. I concur fully in his comments. I would like to add that in our medical school Dr. George Summer and Dr. John Hill in collaboration have developed automated methods for the early detection of metabolic abnormalities in children which are associated with subsequently developing disease processes. The techniques of these two investigators make possible early institution of preventive and protective measures. Thank you for your inquiry. ISAAC M. TAYLOR, M.D., Dean. DEAR SENATOR NEUBERGER: Dr. Isaac M. Taylor, dean of the school of medicine, University of North Carolina, has asked me to answer for him your letter of August 23. My answers to the questions you propose are as follows: 1. I think very definitely that there is going to be an increasing role for "multiphasic health screening" in health care in this country. However, I think that there will be problems in the acceptance of multiphasic screening programs both by the public and also by the medical profession. Some of these problems relate to questions concerned with the time and expense for the patient which may be involved in ruling out false positive screening tests. Other questions relate to whether or not such screening programs should be set up in connection with the actual practice of medicine to better insure physician involvement in the responsibility for their proper use and interpreta tion. 2. Dr. Robert R. Huntley of the staff of this medical school is the faculty member who has perhaps had the most experience with multiphasic screening programs. His experience is unusual in that some of it has related to the actual use of screening procedures in connection with the private practice of medicine. 3. I don't believe that I would want to attempt to give a quick and superficial answer to your suggestions for effective screening programs for persons below and above age 60. Some of the obvious suggestions are readily available in connection with the discussion of results of other programs. I would be glad to attempt to develop some suggestions in collaboration with my colleagues for later transmittal to you if this were considered important. 4. I have mentioned the name of Dr. Huntley as a local resource. You have already mentioned the experience of the Kaiser Foundation in California. Their guidance would be invaluable both because of the automation they have achieved in the carrying out of their screening procedures and also because their screening procedures are done in connection with the active practice of medicine. I think also the Health Insurance Plan of New York would be another source of information about screening procedures. Hoping this information will be of some benefit to you, I am, WILLIAM L. FLEMING, M.D., Assistant Dean. THE UNIVERSITY OF NORTH DAKOTA, SCHOOL OF MEDICINE, MAURINE B. NEUBERGER, OFFICE OF THE DEAN, Grand Forks, October 21, 1966. Chairman, Subcommittee on Health of the Elderly, DEAR SENATOR NEUBERGER: I am very late in answering your letter of August 23, 1966. This is a basic science 2-year school of medicine and as such we have no clinical faculty. We have no residents or interns in this community and therefore, no local programs underway. 1. To answer your direct questions, I think there is a place for multiphasic health screening in health care in our country. There is cer tainly not enough medical manpower that is, physicians to do this job. We would have to develop aids of some sort like the Navy has with corpsmen to do the initial phases of the routines. 2. We have made a laboratory contribution to a communitywide test for diabetes in the past which worked very well. Dr. E. A. Haunz, 221 South Fourth Street, Grand Forks, an intern interested in diabetes, spearheaded the program. It was highly successful and we found a number of hitherto undiscovered cases. We have had a screening program for glaucoma in cooperation with the Division of Vocational Rehabilitation, 418 East Rosser, Bismarck, N. Dak., with Merle Kidder as the head. We found some borderline cases in the older age group. 3. One area of health screening which is relatively simple to identify but extremely difficult to do anything about is the problem of obesity. As patients get older their fat becomes a burden. A weak heart, diabetes, blood pressure, and all sorts of things are much worse when the patient is fat. Heroic measures are sometimes needed to convince the people that a rigid diet is necessary, and where it can be done, it does pay off. This I would feel is the most fruitful area. Again I am sorry to be so delayed in writing this letter, but in a first reading I thought we had nothing to suggest. I recall your visit and very effective talk at the fieldhouse a few years back on the "Hazards of Smoking." As I remember, it was well attended and the talk well received. Best regards, T. H. HARWOOD, M.D., Dean. THE UNIVERSITY OF OKLAHOMA MEDICAL CENTER, Hon. MAURINE B. NEUBERGER, DEAR SENATOR NEUBERGER: Your recent letter to Dr. James L. Dennis, dean of the University of Oklahoma School of Medicine, has been called to my attention with the suggestion that I communicate to you some of our experiences in the State with multiphasic screening programs. The Oklahoma State Department of Health has had extensive experience with a mobile unit multiphasic screening program initiated in 1958. At the request of a civic sponsoring organization, the local physicians and the local health department, the mobile unit will spend from 4 to 12 weeks in a county, handling up to 80 persons per day. Tests currently in use include height and weight (for overweight), pulmonary function tests, chest X-ray (read for tuberculosis, heart size, and other pathology), hemotocrit, blood glucose, blood pressure, abbreviated electrocardiogram, tuberculin skin test, and cervical cytologies. This unit has been in continuous operation since 1960, and has at times had a waiting list of as many as 18 counties in Oklahoma attesting to its popularity with both the public and physicians. I take the liberty of enclosing two articles describing the unit and some of the results from the program. I was involved in the initial development of this program (1960–62) and recognize many of the problems inherent in such programs relating to public and physician acceptance. The key to the success of this program, I am convinced, lies in the early inclusion of the physicians in each county in the planning phases. A more extensive discussion may be found in the enclosed reprints. My present impression is that only a few of the screening tests, most notably cervical cytology and tonometry (glaucoma), are of demonstrable value in reducing morbidity or mortality. Unquestionably, many unrecognized and asymptomatic cases of hypertension, diabetes, arteriosclerotic heart disease, and chronic lung disease can be picked up in population screening programs. The next obvious question is, "Is there anything that a physician can do for such individuals which will reduce morbidity or mortality?" This is particularly true for the asymptomatic person over age 60. Before extensive case-finding pro grams are developed to detect these diseases, we should have evidence in hand that early detection is going to improve the health of these individuals. With a few exceptions (cervical cytology and tonometry), I don't think this evidence yet exists. Cost analyses of the operations are discussed in the attached reprints. If we can provide any further information on specific aspects of this program, please let us know. Sincerely yours, ROBERT D. LINDEMAN, M.D. UNIVERSITY OF PENNSYLVANIA, Hon. MAURINE B. NEUBERGER, Chairman, Subcommittee on Health of the Elderly, DEAR SENATOR NEUBERGER: In reply to your letter of August 23, I want to congratulate the Subcommittee on Health of the Elderly for their wisdom. You are absolutely right in your opinion that multiphasic screening programs should and will play an increasingly important role in the medical care of our citizens of every age. We at the University of Pennsylvania are currently planning a major push along these lines. As you probably know, there is now available automatic instrumentation (a Swedish instrument, I believe) which can do 30 analytical procedures on an extremely small sample of blood in several minutes. There is simply no doubt in my mind that within 5 to 10 years a number of medical centers and regional hospitals will have the facilities to do a biochemical profile on all patients admitted to their hospitals. The National Institutes of Health are doing pioneer work on this at the present time in an effort to reduce the costs per determination from approximately $1 hopefully to 25 cents. Should this be possible, for a total cost of $7.50 to $10 a mass of important information could be presented to the physician before he sees the patient. To say that this would result in enormous improvements in medical diagnosis and possibly effect the saving of many lives would be an understatement. I would prefer you to a more modest experiment which has been going on at Duke University Hospital during the past year or two. If I recall the data correctly, a battery of some 10 to 12 tests was routinely run on half of the patients entering the hospital. The other half were handled by the professional staff in the usual way. I have been told that 25 percent of the first group had abnormal findings which were not detected by physical examination. If these figures are correct, and they should be checked out, this provides very significant evidence of the benefits to be derived from such a procedure. I believe this more or less answers your question 1. I have no doubt about the public's acceptance of such a program which has a potential of providing such benefits. With regard to question 2, we are planning for the development of just such a facility at the hospital of the University of Pennsylvania which we hope will serve not only our own patients but a number of other hospitals in the region, and in addition may provide a service to many practicing physicians in the area. Our professor of biochemistry, Dr. Howard Rasmussen, has been working hard on these plans, and although we don't expect to have anything going in an effective way in less than 4 or 5 years, we are hopeful that the space and the necessary funding for instruments will be found. The initial outlay is, I believe, very high indeed. Obviously, this kind of program can serve patients of all ages. Finally, I am completely convinced that these developments will have an enormous impact on the pattern of medical care in this country. I wish you and your committee much success, and hope you will feel free to call on me if I can ever be of any help. Sincerely yours, SAMUEL GURIN, Dean. UNIVERSITY OF PUERTO RICO, Senator MAURINE B. NEUBERGER, SCHOOL OF MEDICINE, San Juan, P.R., September 13, 1966. Chairman, Subcommittee on Health of the Elderly, DEAR SENATOR NEUBERGER: A study of modern health screening methods is timely and necessary. There is no question that multiphasic health screening is an extremely important part of health care in our country in all age groups. I believe that there is a need for greater and more efficient use of known methods available, plus need for research for simpler methods where these are not readily available. An example of this need is tuberculosis where we must resort to combinations of tuberculin testing, X-rays and sometimes bacteriological examinations in order to detect the persons who are likely to have active disease. A simple test that would screen out these people would help enormously in preventing disease to the extent that it might be possible to eradicate it within a generation. Our school is responsible for the health care of the northeast region of Puerto Rico which includes about 800,000 persons. For this reason, we are profoundly interested in multiphasic health screening. Yours sincerely, JOSÉ E. SIFONTES, M.D., Dean. THE UNIVERSITY OF ROCHESTER, Senator MAURINE B. NEUBERGER, DEAR SENATOR NEUBERGER: Dr. Donald G. Anderson has referred to me your letter of August 23 about multiphasic screening examinations as it was his feeling that I could best answer your inquiries |