that phase of technological development where screening may be considered. 1. I firmly believe that we are approaching the time when multiphasic health screening may become feasible and desirable. To accomplish this we probably will require additional research of a technological nature and studies on the ways in which we may effectively reach a large portion of the public. There are many indications on the horizon which suggest to me that we are on the verge of developing effective and productive screening programs. I have no doubt that there will be complete acceptance both by the public and by the medical profession, providing it can be shown to be effective. It has always seemed to me that the major problem (aside from our technological developments) has been to determine whether the benefit gain is worth the expense. If cost is of no importance whatsoever, then one can say that any benefits derived from screening are desirable. I do think, however, there is a philosophical point in which we need to ask ourselves whether money spent in this way is more beneficial to the public at large than it would be if spent in supporting some of our lagging patient care programs. I am afraid I am not enough of a wise man to solve this problem, especially at our present state of knowledge. 2. As is the case in medical schools in this country, the Department of Preventive Medicine and Community Health is perhaps most interested in the problem of multiphasic health screening programs. Dr. Thomas Sellers, Jr., is chairman of this department at Emory. Due to a lack of resources, he has not been able to do as much as he would like, but he has very great interest in the field. Certainly, he is the one I would look to for advice in this field and I consider him very knowledgeable. 3. I do not like to have to distinguish between health care programs for those below the age of 60 and those above. It seems to me problems are somewhat similar in both age groups and I dislike to separate those who are older from those who are younger. Such a differentiation is unfair. With this in mind, I have the personal feeling that our greatest lack of medical care in this country concerns the use of facilities other than hospitals. For too long we have equated treatment of disease solely with the hospital. My own feeling is that in the years immediately ahead we must learn to use outpatient facilities much more effectively. This can be in the form of outpatient clinics, doctors offices, etc. I think I see a changing pattern of medical care which may actually go a long way toward conserving precious hospital beds which are so short at the moment. 4. Aside from Dr. Sellers, who is chairman of our department of preventive medicine and community health, I should like to suggest the name of Dr. Mieczyslaw Peszczynski, chairman of the department of physical medicine and director of our physical medicine and rehabilitation research and training center. Dr. Peszczynski has devoted, and continues to devote, a considerable amount of time to the care of such illnesses as strokes and other physically disabling diseases. He is a key person in our school in the development of a good many programs particularly in relation to the aging patient. I believe you would find his advice helpful. Very sincerely yours, 69-803 0-66- -21 ARTHUR P. RICHARDSON, M.D., Dean. THE GEORGE WASHINGTON UNIVERSITY, Hon. MAURINE B. NEUBERGER, Washington, D.C. SCHOOL OF MEDICINE, Washington, D.C., September 1, 1966. DEAR SENATOR NEUBERGER: Dr. John Parks, dean of our school of medicine, indicated in his recent reply to your letter of August 23 that I had some experience in multiphasic screening programs. My work has been largely in the laboratory phase of such programs, i.e., the development and organization of a clinical laboratory to do large numbers of tests specifically selected for use in the evaluation of the health of aging persons. The laboratory which I organized was highly automated, and was first presented as a working demonstration for the 1961 meeting of the American Medical Association in New York City. At that meeting we performed 14 tests on each of more than 2,000 physicians, a total of some 28,000 tests, in a 5-day period. Subsequently the laboratory, under my direction, was feature of the 1962 (Chicago), 1963 (Atlantic City), and 1964 (San Francisco) meetings of the AMA. For the last 2 years Dr. Vernon Martens of the Washington Hospital Center, this city, has continued this project which has from the beginning been presented jointly by several national pathology societies, with financial support from the Division of Chronic Diseases of the U.S. Public Health Service. Enclosed is a brochure, prepared for distribution at the 1964 exhibit laboratory. In it I have outlined the concept and operation of such a laboratory. Feel free to call on me if you think I can be of any help. Sincerely yours, THOMAS M. PERRY, M.D., Chairman, Department of Pathology. THE HAHNEMANN MEDICAL COLLEGE HOSPITAL OF PHILADELPHIA, Philadelphia, Pa., August 29, 1966. Hon. MAURINE B. NEUBERGER, Chairman, Subcommittee on Health of the Elderly, Special Committee on Aging, U.S. Senate, Washington, D.C. DEAR SENATOR NEUBERGER: I wish to respond to your letter of August 23 regarding the study which the Subcommittee on Health of the Elderly is making of modern health screening methods. I will address myself to the specific questions which you ask. 1. I believe that the value of health screening methods has been established during the past 20 years by such programs as the chest X-ray survey conducted by the National Tuberculosis Association, the Pap smear technique for the detection of uterine cancer, the blood sugar program of the National Diabetic Association, and the annual physical examination program conducted by so many industrial corporations for groups of their employees. New automated devices for laboratory tests and computer analysis of EKG's will make multi phasic screening programs much simpler and applicable to larger groups of the public. 2. The Department of Pathology of the Hahnemann Hospital has been interested in the automation of laboratory procedures, and Dr. Joseph Imbriglia, professor of pathology and director of the clinical laboratory of the Hahnemann Hospital, would be happy to furnish you with any additional information on this matter. In addition, the Department of Medicine of the Hahnemann Medical College recently has undertaken a multiphasic health screening program with the Carpenters' Union of Philadelphia, and Dr. John Moyer, professor of medicine, would be in a position to advise you about this matter. 3. I would feel that for persons under age 60 we should confine our screening according to certain groupings: extend the school health programs through high school and college and professional schools, study means of requiring more extensive employee health surveys with emphasis on aspects of health conditions which are related to the type of employment, and developing more efficient means of following up familial illnesses in all members of a family when such illnesses are detected. Such selected programs, however, will not be adequate for the group over age 60, and I believe that more effective mass screening of the entire population needs to be developed for the elderly category. 4. See No. 2. I appreciate your writing to me on this occasion and I hope these comments will be helpful to the members of your committee. Sincerely yours, WILLIAM F. KELLOW, M.D., Dean. Hon. MAURINE B. NEUBERGER, HOWARD UNIVERSITY, Washington, D.C., August 31, 1966. Chairman, Subcommittee on Health of the Elderly, DEAR SENATOR NEUBERGER: In response to your letter of August 23, 1966, I am assuming that it was addressed to Dr. Robert S. Jason as dean of the college of medicine. Dr. Jason is no longer dean of the Howard University College of Medicine and has been given a new assignment by the university. I am now dean of the college of medicine and hence am taking the liberty of answering your letter. In response to the first question regarding the role and acceptance of a multiphasic sceening program, I would say that this type of program has a definite role and would fill a definite need in the modern practice of medicine. There would have to be a strongly supportive educational program to develop acceptance on the part of the public. Inasmuch as results would be made available to the individual's private physician, I would not anticipate large-scale resistance from the medical profession. However, some resistance to change would have to be anticipated as is true with many new health programs. Our hospital as a whole, with its many specialty clinics, does a job of screening but obviously does not compare in terms of timesaving and in serving apparently normal segments of the population. We get, primarily, those with illness due to disease rather than those with disease without illness. Our faculty and staff have not participated in a multiphasic screening program, but many of them have received reports on their patients from the District of Columbia Health Department's project. In the initial establishment of such a program, I think that the involvement should be with the age group among whom chronic disease is more prevalent; to wit, those over 50 or 60. In subsequent years it might be feasible to involve younger age groups. In the District of Columbia we can only cite the District of Columbia Health Department, of which you are already cognizant, which has developed, we believe, an excellent prototype for multiphasic screening. Sincerely yours, K. ALBERT HARDEN, M.D., Dean. INDIANA UNIVERSITY, SCHOOL OF MEDICINE, Indianapolis, Ind., September 19, 1966. Hon. MAURINE B. NEUBERGER, DEAR SENATOR NEUBERGER: I asked Dr. Edwin W. Brown, Jr., associate professor of preventive medicine at our school of medicine, to review your letter of August 23, 1966, concerning your Subcommittee on Health of the Elderly of the U.S. Senate Special Committee on Aging. I am enclosing the notes of Dr. Brown, which I hope will be of some assistance to you. Since Dr. Brown has just recently joined our faculty, he has not been able to answer your questions in detail. If in the future you wish to consult our school concerning this subject, please contact Dr. Edwin W. Brown, Jr., here at our school of medicine. Sincerely, GLENN W. IRWIN, Jr., M.D., INDIANA UNIVERSITY MEDICAL CENTER INTERDEPARTMENTAL COMMUNICATION To: Dean Glenn W. Irwin, Jr. From: Edwin W. Brown, Jr. Subject: Senator Neuberger's letter. Although I have had no personal experience with multiphasic screening programs, I am not aware of any as sophisticated as that of Collen in Oakland, to which Senator Neuberger refers in her letter. Except for several papers of Collen's, there is not much in the medical literature on such programs, reflecting, I suspect, a real lack of sound evaluation of most screening procedures, other than a few, such as mass chest X-ray, which have been widely employed. It seems obvious that the greatest defect of a multiphasic screening program (and doubtless one which has characterized many of those that have been carried out) is the problem of following up the cases which have been detected, for without such followup there is no way of judging the effectiveness of the program, both in terms of the validity of the screening procedures employed and the value of the program in preventing the ultimate effects of the diseases for which patients have been screened. I would therefore think that unless the proposed screening centers outlined in Senator Williams' Adult Health Protection Act were very carefully planned so as to include an effective mechanism for followup, one might question their value, in view of the large expenditure of funds that would be required to provide the elaborate screening that Collen has employed. Since the hearings to be conducted by Senator Neuberger's subcommittee are only a few days away, and since I have not had an opportunity to meet with Mr. DeFrance at Flanner House to learn something of their screening program (having only just learned of that activity's existence), I hesitate to suggest that a telephone call be made to the subcommittee to determine whether they would be interested in having Mr. DeFrance (or other persons connected with the Flanner House program) attend the hearings. However, perhaps you would wish to consider that possibility in the light of your own knowledge of the Flanner House program. THE JEFFERSON MEDICAL COLLEGE AND MEDICAL CENTER, Hon. MAURINE B. NEUBERGER, Chairman, Subcommittee on Health of the Elderly, US. Senate, Special Committee on Aging, Washington, D.C. DEAR SENATOR NEUBERGER: Thank you for your letter of August 23 regarding modern health screening methods in prevention of chronic disease. I am sorry I have not been able to answer previously. I have been out of the country. I am very familiar with the multiphasic screening program conducted at the Kaiser Foundation in California and with other similar techniques as well. You asked four questions. I shall answer them according to your numbers. 1. There is a very significant place for multiphasic health screening in health care in our country. Such methods do not go into the details of historical analysis and other items which might evoke the presence of disease or tendencies toward disease. In other words, these methods have their limitations. However, within the framework of the understanding of this fact, they are important. 2. I have participated in the organization and operation of multiphasic health programs in the past. 3. The answer to this question concerning effective screening or other health maintenance programs for persons above and below the age of 60 would be a long discussion. Suffice it to say that as individuals get older, these examinations become more and more important. |