made of steel-comes out unscathed, and the other shatters like glass. So much for philosophy.

Secondly, we differ in our mode of operation. In this regard, there are a number of departures. I have chosen two, to illustrate the point. Coming from a California area, I am most keenly aware of how inflammatory is the word "diet." And I am mindful of how controversial is nutrition. We recognize that this is not a panacea. But we are also aware that to ignore it is just as wrong. As far as I know, according to the published record of every multiphasic screening program, no provisions are made for nutrition. This is one of our major departures. We have built into our program dietary analyses, and biochemical testing for diet and nutrition.

Our second great departure in terms of our modus operandi deals with our criteria for health. It may, Madam Chairman, come as somewhat of a surprise to you to learn how standards for health are created. The simple fact is that almost without exception, our standards for health and disease are designed by testing a presumably healthy sample, obtaining an average, and a so-called statistical standard deviation or deviations which embraces 95 percent of the population around that average, and it is then assumed that what lies within that 95-percent range is healthy.

The illogic of that is abundantly evident. If that is health, then dental caries and pyorrhea are healthy, since 95 percent of the people have it. Accordingly, one of the most critical ingredients in the health program is to have realistic standards, not standards so broad that one is obviously sick when one is outside of its limits. Regretfully, in most multiphasic screening programs, the standards are that broad, and this is our second point of departure.

I made mention before that when one strips the outer layer off the sphere there is a layer of performance. This usually is disturbed before there are the usual ravages of disease, like an atrophic arm or a cancerous canker. As Dr. Weber has pointed out, we are fortunate in having a great amount of material on performance in the industry, based on disability, pensions, sickness, and absenteeism. This information has been programed in, so that we have the opportunity of relating the outer core, obvious disease, to the center, to the middle layer, performance, to the central core, the chemistry. If we do the job that we hope to do, there should be changes at all of these levels. And, finally, we are at variance with most of the programs, if not all of them, according to the published record, in that we recognize that any such program will delineate three groups of people those who are obviously sick, those who are optimally well, and those in the large gray area that receive little attention. The man, for example, with a little bit of arthritis. We have tooled up, as it were, so that these individuals—particularly the middle group, especially-will be provided with the opportunity of attending a health education course. We now have a Ph. D. in health education, who has been doing this kind of work for years, and who will make available to the membership lectures and demonstrations and pamphlets, and motion pictures and film clips. After a set period, we shall recall these people, and run them through our program again so that we can check on our quality control.

If these health education experiences have been fruitful, then there should be benefits in the program. This, broadly speaking, I believe, are our major departures from most of the multiphasic screening programs. We have kept our remarks very brief, with the hope that we would have time for whatever questions you wish to ask.

Senator NEUBERGER. Yes, a lot of questions come to my mind. I can just start in on some, one of which is, How do you get people involved in this program?

Dr. CHERASKIN. How do we get people involved in this program? We are fortunate in that we are with a group who have as a leadership health-minded people. And it just takes a powerful leader to move people. Usually great things are accomplished by small groups. I think we have just been lucky. Our experience so far has indicated that there will be no problem getting people.

Senator NEUBERGER. Well, now, you get people to come, and do they take instruction or nutrition, diet, health? Just physically, how is this carried out?

Dr. CHERASKIN. We have not mentioned that for obvious reasons, but I would be pleased to tell you about it. An individual writes in or calls in requesting permission to join the program.

Senator NEUBERGER. Now, this individual is a member of the union?

Dr. CHERASKIN. Or a dependent.

Senator NEUBERGER. Yes.

Dr. CHERASKIN. Of the Retail Clerks Local 770. These applications have been made available in their newspaper, and through a number of other sources; in the stores where they work. It is hard to miss them; and at their meetings this is discussed, and there are other kinds of propaganda distributed. Be that as it may, they have the opportunity for writing in or calling in, and they are sent forms to complete with vital statistics which we must know, and what day they can best come in. They are sent a booklet explaining what the program will be like.

At some point, they come in and are registered and then, complete a questionnaire which is somewhat more automated than Dr. Collins', and less automated than the Linc system. We, too, would like to have the Linc system. I should remind you, this is a private venture with no Government funds. The program is accomplished with 1 penny per working hour derived from approximately 24,000 or 25,000 people. Senator NEUBERGER. Well, what percentage of response then do you have from your membership?

Dr. CHERASKIN. This cannot be answered completely at the moment, because we are just getting off the ground. There is no shortage of people to be operational at this point. If we could just keep going that way, we shall have all the response we need.

Senator NEUBERGER. All right then. We have the diet, nutrition. Dr. CHERASKIN. The participants answer a questionnaire, have their height and weight and ankle jerk tested along with blood pressure and pulse and temperature. A series of parotid-salivary-studies are done, a number of breath analyses are taken. Urinalysis for sugar, protein, and so forth is accomplished. The rest of the tests include the usual automated chemistries that are available by the SMA-12, plus a

series dealing with fat metabolism, because of its relation to heart disease.

On that basis, and through programing, these people are identified as being sick or well or in between. They are categorized, and, of course, the very sick must be sent to their physicians. We are developing a feedback system from them. Now the rest are invited to join the health education program, if they wish. This is made available to them. We do not expect a hundred-percent response. But we will be satisfied with something much less than that. And after that health education experience, they will be requested to come through the program again, reevaluated. If our program is successful, then we shall have the answers, in house.

Senator NEUBERGER. But in this screening test, then you have something that is comparable to the ones we have been hearing about. Dr. CHERASKIN. Oh, indeed.

Dr. WEBER. Plus some very important new tests related to new measurement concepts.

Dr. CHERASKIN. Breath.

Dr. WEBER. For example, we do a breath analysis on every subject that comes through. We are looking at nine components in the breath. These components occur in very small concentrations, but they do give us possible indication of several diseases. By the same token, we are also doing salivary analyses in order to develop new predictive indices. Senator NEUBERGER. There comes to mind one thing right now, because there is a great deal of to-do in the country over the issuance of warnings by Dr. Goddard about the value of food additives-I mean, those that are sold for nutritional value; I don't mean preservativesand the questioning of whether vitamins or synthetic vitamins, purchased vitamins, are doing the job. Now, where do you stand for source material, in teaching nutrition and diet?

Dr. CHERASKIN. Well, of course, this has nothing fundamentally to do with the program, but I certainly have a view, and I trust it is based on facts. I am not aware of where Dr. Goddard received all of his facts, and I understand he is under some fire from other people, who also have some information. I do not know the basis for his statement, frankly. I would appreciate hearing it.

Senator NEUBERGER. I think it would be easy to get.

Dr. CHERASKIN. The facts?

Senator NEUBERGER. The question is, Well, who do you go to? Whom do you call for facts?

Dr. CHERASKIN. Well, I think the only way that people like myself as clinical investigators can operate is to have a hypothesis. All of us live by hypotheses. We walk across the street with the green light, because the presumption is that it is somewhat safer, though it is not 100 percent. In our business, we have a hypothesis, and we test it. We take people, we give them supplements. If people are not eating well, then they should fare better with the supplements. We have done such studies, reported some 200 of them, which are in my curriculum vitae attached to my statement. I would simply like to see Dr. Goddard's facts.

Senator NEUBERGER. Well, it is not too far down there. I am sure while you are here in Washington, you should go down and talk to him. He probably would be glad to talk to you about it, because, as

if my

you say, he is under fire. The fire seems to come, office is any indication, from people who have been sent cards to mail to their Congressmen, or who send me pages out of health fact books, and diet supplement material.

Dr. CHERASKIN. I do not believe that is true. The Food and Nutrition Board, which is a very respectable organization, has challenged some of Dr. Goddard's statements.

Senator NEUBERGER. That might be, but I mean the ones that are flooding us.

course.

Dr. CHERASKIN. That is very possible. I am not aware of that, of Senator NEUBERGER. I think a real close investigation of some of these statements from FDA, what they are really trying to do is to instruct people that requirements for a good, well-balanced diet with vitamins and nutrients can be found in a well-balanced diet, and that some of these things that people think they need to be healthy don't do them any harm, but they just cost them a lot of money.

Dr. WEBER. This is not in any way a food fad or a fadist program. It is run by a nutritionist with a doctor's degree, and with several years' experience. I am sure

Senator NEUBERGER. But all the stuff that comes to me-and there is a flood of propaganda coming in that is inspired by the groups-it is all form cards that are given to people at health food stores, or things like that, and they say they cannot live without it; the vitamin, or the added nutrient, or peanut oil, or whatever it is.

Dr. CHERASKIN. Well, as I indicated, this is highly inflammatory. I am keenly mindful of that. To ignore it because it is inflammatory, would be, I think, negligence on our part. We are trying to put it in its proper perspective. In the statement which I prepared there, there is a quote from Dr. Willard Krehl, a very respected man at the University of Iowa, pointing out that today, if there were one item that could be introduced to do more for chronic disease than any other, it would be in hygiene and nutrition.

That statement is in my report. I do not know of anybody who questions Dr. Willard Krehl's qualifications.

Senator NEUBERGER. Do you advocate to these people who take predictive medicine that they can arrange their own nutritious diet without the purchase of synthetics, or ever eating saffron oil, or whatever it is?

Dr. CHERASKIN. Yes; there are lectures and even on how to cook. Senator NEUBERGER. So they don't have to go and buy a lot of fancy foods, or

Dr. CHERASKIN. Some do, some do not. There are people who need them in spite of diet. For example, all other things being equal, one who smokes has vitamin C levels half as high as one who does not smoke.

Senator NEUBERGER. Do you advise him to quit smoking?

Dr. CHERASKIN. Well, naturally. If not, at least to take more vitamin C.

Senator NEUBERGER. It is very interesting. You have presented us with a new approach that we haven't had before, and I am glad to have this in the record. I have one more witness that I have to get to in the next few minutes.

So thank you very much, and I now call on Dr. Chinn, who is the Chief of the Gerontology Branch, Division of Chronic Diseases of the U.S. Public Health Service.

STATEMENT OF AUSTIN B. CHINN, M.D., CHIEF, GERONTOLOGY BRANCH, DIVISION OF CHRONIC DISEASES, U.S. PUBLIC HEALTH SERVICE

Dr. CHINN. Madam Chairman. I am delighted to be here, and consider this a real honor, to be the final witness in these important 3-day hearings.

At the same time, I recognize that this is a very considerable responsibility, since inherent in this finality, I suppose is that of doing something toward bringing the 3-day hearing proceedings into focus. I have already submitted a statement, which you have, I presume, and I would like the privilege of digressing from this, if Î may.

I would like to talk from two points of view, in the few remarks that I am going to make; that as a member of the staff of the Gerontology Branch in the Division of Chronic Diseases, as well as an ex-practitioner of medicine.

I think it important, particularly at this time, that we bring together these two elements in our health programs, which are so inherently important to the country.

I think that all has been said that can be said, about the detection of disease in its early phases; by a wide variety of very competent people. We have had educators, medical practitioners, public health people, electronic experts, mathematicians, economists, and so forth, to testify relative to these various facts.

And so what I am going to say are rather general remarks which are the result of the influence, you might say, of these hearings on the thinking of a person who is both concerned with public health, and the clincial practice of medicine.

It seems to me that the hearings have clearly demonstrated that the country in its health efforts is at a very definite point in the road at which it must select new approaches. I say that for the very reason that at this point in the road, or at this point in time, there seems to be the necessity to reexamine what we now have, what has been done in the past, and what we might hope to do in the future.

Up to this time, we have seen an enormous effort in research, much of it research in the basic mechanisms of disease, the cure of illness, and which, one would not hesitate to say, has been enormously profitable.

For the service point of view, we have seen, tremendous advances made toward the management of sickness. These advances have been in the direction of the building of better institutions, of more institutional beds, better techniques in management of sickness, and, of course, the education of great numbers of health professionals, directed toward the management of sickness.

So the focus has been, from a service point of view, entirely on sickness.

Now are we to continue with this? Is it that we are to be content with the problem of sickness alone?

Let us suppose that we are. Let us suppose that we continue to do as we are doing today. About 5 percent of the people in the United

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