minimum of time and cost. The findings help the physician complete the health examination of more individuals in less time by providing him with documented results of many tests performed by technicians on apparently well persons. This program was supported by a Public Health Service grant, and I am sure you will be hearing more about it in later testimony. Recent advances in the field of automation clearly present us with most welcome opportunities to make medical testing services more widely available, to heighten their effectiveness, and I hope, to bring down costs. I suspect, however, that we still have a long way to go to achieve general acceptance of some of these new-fangled approaches to medical care. Although Americans have a reputation for loving gadgetry and mechanical contrivances, we are still conservative about making changes in what we consider to be basic institutions. For this reason, the role of the innovator in such fields as education and medicine-(especially the latter) is not always easy or comfortable. Nevertheless, the trend is clear-automation must be wedded to medical care and the public will come to accept new methods of receiving care. Otherwise, we will not meet the challenge of making available to every American the best that medical research has to offer and doing so in time to prevent or curb the risk of disease and disability. Meeting this challenge to stretch limited resources, to satisfy the rising demands for health protection for growing numbers of people all this must be the next major phase in the development of health care in this Nation. It is my fervent hope and belief that the expert witnesses whom you have called upon will deal with these issues in detail during these important hearings. Along with you, I will be looking for answers to some very serious problems. What, for example, are the values and limitations of periodic health appraisal in preventing untimely death, long-term illness and disability? Can we measure these? Is it really impractical to think of preventive care for all of our adult population? Is it really a question of simple arithmetic-too many examinations X(times) too many people X (times) too few doctors? Can we bring to bear the results of research and new developments in medical technology so that what looks at times to be an impossible equation emerges as just another difficult problem to be solved? Can we afford the time required (under the best of circumstances) for massive preventive programs when we have so many sick people who need more and better attention right now? Conversely, can we afford the loss of life or lessened capacity to live as productive human beings which will surely continue if we do not pay greater heed to health protection for the adult? I had the opportunity of expressing my convictions about health protection when I introduced the Adult Health Protection Act in the House. (Your colleague, Senator Harrison Williams, introduced a companion bill in the Senate.) My bill would authorize the Surgeon General of the Public Health Service to make grants to medical schools, community hospitals, health departments, and other nonprofit agencies to establish and operate adult health protection centers. It would authorize grants for the establishment and operation of these centers for a period of five years. The system envisioned in my bill will do more for preventive medicine and health protection than anything yet proposed. In addition to many other features, it will bring modern instrumentation and computer use to bear on the recognized, growing health problem represented by chronic illness and the increasing scarcity of professional health personnel. I propose for the first time to provide Federal assistance in the establishment and operation of regional and community health protection centers for the detection of disease; to provide assistance for the training of personnel to operate such centers; and to provide assistance in the conduct of certain research related to such centers and their operation. While these adult health protection centers are intended to provide an efficient means for the detection of abnormalities or indications of disease, they would not replace full examinations. Their purpose is to place in the hands of the examining physician a summary of basic data and to place promptly under a physician's care a person with indications of disease conditions. The health protection centers would conduct training programs in the operation of technical disease detection procedures and would research and develop new disease detection tests and equipment. Additional grants to the centers would be authorized for operational research and for the establishment of internships to give on-the-job training to physicians, nurses, and technical personnel. The centers would also conduct community education programs on preventive health care. minimum of time and cost. The findings help the physician complete the health examination of more individuals in less time by providing him with documented results of many tests performed by technicians on apparently well persons. This program was supported by a Public Health Service grant, and I am sure you will be hearing more about it in later testimony. Recent advances in the field of automation clearly present us with most welcome opportunities to make medical testing services more widely available, to heighten their effectiveness, and I hope, to bring down costs. I suspect, however, that we still have a long way to go to achieve general acceptance of some of these new-fangled approaches to medical care. Although Americans have a reputation for loving gadgetry and mechanical contrivances, we are still conservative about making changes in what we consider to be basic institutions. For this reason, the role of the innovator in such fields as education and medicine (especially the latter) is not always easy or comfortable. Nevertheless, the trend is clear-automation must be wedded to medical care and the public will come to accept new methods of receiving care. Otherwise, we will not meet the challenge of making available to every American the best that medical research has to offer and doing so in time to prevent or curb the risk of disease and disability. Meeting this challenge to stretch limited resources, to satisfy the rising demands for health protection for growing numbers of people all this must be the next major phase in the development of health care in this Nation. It is my fervent hope and belief that the expert witnesses whom you have called upon will deal with these issues in detail during these important hearings. Along with you, I will be looking for answers to some very serious problems. What, for example, are the values and limitations of periodic health appraisal in preventing untimely death, long-term illness and disability? Can we measure these? Is it really impractical to think of preventive care for all of our adult population? Is it really a question of simple arithmetic-too many examinations X(times) too many people X (times) too few doctors? Can we bring to bear the results of research and new developments in medical technology so that what looks at times to be an impossible equation emerges as just another difficult problem to be solved? Can we afford the time required (under the best of circumstances) for massive preventive programs when we have so many sick people who need more and better attention right now? Conversely, can we afford the loss of life or lessened capacity to live as productive human beings which will surely continue if we do not pay greater heed to health protection for the adult? I had the opportunity of expressing my convictions about health protection when I introduced the Adult Health Protection Act in the House. (Your colleague, Senator Harrison Williams, introduced a companion bill in the Senate.) My bill would authorize the Surgeon General of the Public Health Service to make grants to medical schools, community hospitals, health departments, and other nonprofit agencies to establish and operate adult health protection centers. It would authorize grants for the establishment and operation of these centers for a period of five years. The system envisioned in my bill will do more for preventive medicine and health protection than anything yet proposed. In addition to many other features, it will bring modern instrumentation and computer use to bear on the recognized, growing health problem represented by chronic illness and the increasing scarcity of professional health personnel. I propose for the first time to provide Federal assistance in the establishment and operation of regional and community health protection centers for the detection of disease; to provide assistance for the training of personnel to operate such centers; and to provide assistance in the conduct of certain research related to such centers and their operation. While these adult health protection centers are intended to provide an efficient means for the detection of abnormalities or indications of disease, they would not replace full examinations. Their purpose is to place in the hands of the examining physician a summary of basic data and to place promptly under a physician's care a person with indications of disease conditions. The health protection centers would conduct training programs in the operation of technical disease detection procedures and would research and develop new disease detection tests and equipment. Additional grants to the centers would be authorized for operational research and for the establishment of internships to give on-the-job training to physicians, nurses, and technical personnel. The centers would also conduct community education programs on preventive health care. Finally, a 12-man Advisory Council on Adult Health Protection would be established to advise the Surgeon General of the Public Health Service in the administration of this program. This Council will include men who are leaders in the fields of medicine, public health, public welfare, or representatives of national organizations concerned with the interests of the aging. And it shall include one or more national leaders known for their dedication to the national interest and the welfare of the Nation's citizens. The basic idea behind the act, put simply, is this: to launch a genuine, nationwide preventive medicine campaign. By making these testing services available to any person age 50 or above, on a voluntary basis, we will encourage men and women approaching retirement to take regular health examinations and we will facilitate the giving of full examinations by practicing physicians. When I introduced my bill in the House, I said essentially what I have said here: that the chronic diseases pose the greatest threat to health today, that prevention and early control is our only true weapon against these diseases and that, as a result, the means must be found to extend the best of preventive medicine to the greatest numbers of those who run the risk of chronic illness and disability. I firmly believe this, and I believe, too, that these hearings will serve to speed the day when preventive medicine will be practiced more than it is preached to the end that all Americans will not only live longer but enjoy longevity. Senator NEUBERGER. From talks with many of the witnesses who will now testify, we know that the topic of these hearings has generated excitement and interest in the medical community. We believe the time has come for us to share that mood with the Senate and the people of this Nation. Our leadoff witness is Dr. Robert Ebert, who is dean of the Harvard Medical School. In addition, Dean Ebert serves as a trustee or director of numerous societies and foundations and he is a member of the President's National Commission on Health Manpower. So, I welcome you, Dean Ebert, as our leadoff witness. If you will, come up here to this table, please. I am sure the witnesses will say, and I want to say it also, that I believe, in exploring this problem, we should differentiate between screening tests and a physical examination, and I think we have to keep that in mind. Dean Ebert. STATEMENT OF ROBERT H. EBERT, M.D., DEAN, HARVARD MEDICAL SCHOOL, CAMBRIDGE, MASS. Dr. EBERT. Senator Neuberger, Senator Williams, I wish, first, to thank you for the privilege of appearing before this committee. I would agree with all of the remarks that have been made about its intrinsic importance. I thought what I would do this morning, with your approval, is to attempt to put this, the matter of early disease detection, multiphasic screening, in some perspective in terms of health needs. I think all of us would agree that our Nation's most important asset is people and while we are blessed with great natural resources, only people can really be creative and productive and our ultimate future depends upon the welfare of our citizens. If this human asset is to be nurtured, the best possible environment must be created for the individual and this must include adequate health services for all. A defense can be made for any program which contributes to the Nation's health and if our resources were limitless, there would be little point in assigning priorities to one program or another. Since we must face the limitations of money and manpower, some choice must be made and priorities must be set on the basis of what is feasible and what accomplishes the most for the Nation's health. No one would argue that disease prevention is the most valuable contribution which medicine can make to society. The work of Enders, Weller, and Robins followed by the development of a vaccine against polio by Salk and Sabin was a far more important contribution to the health of the world than all the treatments devised for the acute and chronic care of the polio victim. Similarly, immunization against smallpox, diphtheria, and most recently, measles, represents milestones in the prevention of disease. Immunization has not been the only weapon in the conquest of disease. Mosquito control can prevent malaria, pure water can control typhoid fever and other enteric infections, and adequate nutrition can eliminate beriberi and pellegra. It is probable that the control of air pollution and elimination of smoking could eliminate certain kinds of cancer, as well as emphysema. It does not take a statistician to prove the advances you can make in the field of health. Perhaps the next most important contribution which medicine can make is the specific cure for illnesses which may be fatal or which have a high morbidity. By far the greatest excess of great curative medicine has been in the field of disease. Rapid cure of syphilis thereby created the means of controlling this crippling disease. It remains a public health problem, but the development of potent drugs such as isodycin and streptomycin not only offers a cure, but an additional weapon against the spread of the disease. There are other examples of advances which have been made in the field of curative medicine, but these represent two of the most dramatic. Unfortunately there are many diseases which we cannot prevent and many which we cannot cure. Hopefully the money spent on biological research will provide the basic understanding for the ultimate conquest of these diseases. Meanwhile, it would seem reasonable to apply as widely as possible the medical knowledge and skill which we possess to cure the diseases we know how to cure and to curtail, whenever possible, the progress of disease for which there is no specific cure. Yet it is the daily experience of anyone working in a large general hospital to see the late stages of disease which, if discovered earlier, might have been controlled so as to prolong productive life. Death and chronic debilitating illness are always tragic, but the tragedy is compounded if the physician knows that the patient sought medical attention too late. As a Nation we will always wish to provide the best care we can afford for the chronically ill, but it should be noted that the treatment of the end stages of disease is the least productive investment a nation can make in the field of health. There is a limit to the amount of money and manpower which any nation can devote to health. It would seem reasonable, therefore, that the highest priority should go to disease prevention and to early detection and early treatment of disease. I hope I have made it clear that I consider the early detection of disease as one of greatest importance for I would now like to address myself more directly to this subject. In the past there has been much interest and considerable activity in disease detection, but for the most part this has been done on a cate |