because of past experience and recent discussions that we have had here. I will answer your questions in the order they are written in your letter. 1. My personal belief is that there is a place for multiphasic health screening in health care in this country; this view is shared by some individuals in our medical community. There probably will be certain problems in acceptance of such a program by the public. A small number of possibly hyprochondriacal individuals will over utilize the program and possibly show undue concern over the results of the examination. Balanced against this will probably be a much larger proportion of the population who will not utilize the program or if they go through multiphasic screening will not cooperate in followup of any abnormal findings. Acceptance of this type of a program by the medical profession appears to be quite variable, at least in this part of the country. The majority of the physicians with whom I have discussed this believe that it would not help them personally in their present practice. Several of the physicians with whom I have talked have felt that it can be utilized in certain population groups such as migrant laborers, industrial employees, and inhabitants of rural areas without physicians. 2. To the best of my knowledge no one in this area has participated in the operation of a program similar to that carried on by the Permanante Foundation. Certain individual physicians in this community do have a particular interest in this type of a program and probably will be involved in the near future. Their names are as follows: Dr. Robert B. Burton, 277 Alexander Street, Rochester, N.Y. 14607. Dr. Burton is the medical director of the program for the Amalgamated Clothing Workers Union in this city. Dr. Charles B. Sherman, Jr., Strong Memorial Hospital, 260 Crittenden Boulevard, Rochester, N.Y. 14620. Dr. Sherman is the past president of the Medical Society of the County of Monroe and has a particular interest in cancer detection. Dr. James H. Sterner, Eastman Kodak Co., 343 State Street, Rochester, N.Y. 14650. Dr. Sterner is the medical director of Eastman Kodak and he has told me that he is involved in studies of periodic examinations. Dr. Lawrence E. Young, University of Rochester School of Medicine and Dentistry, 260 Crittenden Boulevard, Rochester, N.Y. 14620. Dr. Young is professor of medicine and chairman of the department here in the medical school and chairman of the planning committee for the regional medical program in heart disease, cancer, and stroke. Dr. Ralph C. Parker, Jr., University of Rochester School of Medicine and Dentistry, 260 Crittenden Boulevard, Rochester, N.Y. 14620. My present involvement is as coordinator for the regional medical program in heart disease, cancer, and stroke. I have had previous experience with comprehensive periodic health examinations while serving in the U.S. Navy Medical Corps. We hope, as part of our regional medical program in heart disease, cancer, and stroke, to develop a pilot program in multiphasic health screening. If our experience in the pilot program is satisfactory then hopefully we would spread this by establishing both fixed and mobile units and also by helping to train technicians who could perform this type of service for others. 3. In this question you suggest that there may be a difference between screening health programs for persons below the age 60 and above the age 60. Actually we are considering basing the types of examinations done on individuals not only on age groups which would be more finely divided than over or under age 60 but also on racial background and sex. Certain examinations would be indicated for a person of known ethnic background, male or female, at a certain age. Some of these tests might not be appropriate for an individual falling in another block. It is our present thinking that setting up examinations on this basis will lead to greater efficiency and greater yield. The whole area of periodic examinations or screening examinations has been a matter for debate for some years. Enthusiasts for these programs can produce figures showing the large number of abnormalities picked up by these routine examinations, although apparently not all these abnormalities are of great significance. It has been pointed out by those less enthusiastic over this type of program that it would be completely impossible to involve the total population of this country in any sort of periodic health examination. Probably the application of such a program to certain high risk groups at appropriate intervals would be a reasonable solution at this time. Periodic health examinations are often done once a year; however, it is my experience that the natural histories of various diseases do not conform necessarily to our 365-day year which is based on astronomical rather than biological considerations. This area needs a good objective study by various groups in different parts of the country involving sufficient numbers of people to give statistically valid results. Wider programs could then be developed on the basis of these findings. It would probably be a rather ineffectual use of our fiscal resources and health personnel to precipitate our country into a grandiose screening program that was not adequately based on valid studies. Yours sincerely, Senator MAURINE B. NEUBERGER, Chairman, Subcommittee on Health of the Elderly, DEAR SENATOR NEUBERGER: Thank you for your letter of recent date in regard to the pending hearings on screening methods to detect chronic illness. As in most aspects of the practice of medicine, the problem is not so much the techniques of early detection of disease but in implementation of these techniques. That is, whether it can best be done in the private physician's office or in public clinics or some combination. Our department of preventive medicine, under the direction of Dr. Henry Packer, has had a depth of experience with mass screening techniques over a period of many years at the City of Memphis Hospitals. Dr. Packer and his associates first showed the value of tenometer recordings on all patients presenting themselves to the clinic beyond age 40. I believe that there would be tremendous reaction among the medical profession for federally supported mass screening clinics for all citizens. I therefore believe it should be implemented for the medically indigent group through existing public health channels such as State service funds to local public health departments. For the private patient it can best be done in the private physician's office. Here we in medical education have a great responsibility to emphasize preventive medicine and early detection of disease to our students both on the lecture podium and by precept so that they will practice this kind of medicine. May I refer you to Dr. Henry Packer, professor of preventive medicine, University of Tennessee College of Medicine, 62 South Dunlap, Memphis, Tenn. 38103, who, I think, might have a great deal of interest to say to you and your committee prior to or during your hearings. Sincerely yours, M. K. CALLISON, M.D. THE UNIVERSITY OF TEXAS, Houston, Tex., October 18, 1966. GRADUATE SCHOOL OF BIOMEDICAL SCIENCES AT HOUSTON, Hon. MAURINE B. NEUBERGER, Chairman, Special Committee on Aging, DEAR MRS. NEUBERGER: I regret that your letter of August 31, in regard to health screening, did not reach me until yesterday. A change of address and the pursuant problems of forwarding my mail resulted in this unfortunate delay. It would have been a welcome opportunity for me to comment upon the questions you posed, and especially to affirm the positive values of multiphasic health screening in health care in our country. I followed the press reports of our committee hearings, and was pleased to learn of the support and encouragement that the concept of health screening apparently received. My own comments would have only added additional support. The work of Dr. Morris Collen, at Kaiser, is admirable, and his program offers a prototype which seems most desirable. I shall look forward to reading the details of the committee hearings when they are available. If I can be of any assistance in the future, please do not hesitate to let me know. Please accept my best wishes for your continued success. Sincerely, HELEN L. TINNIN, Ph. D, Associate Professor, Health Education. THE UNIVERSITY OF TEXAS, Hon. MAURINE B. NEUBERGER, OFFICE OF THE DEAN, San Antonio, Tex., September 3, 1966. DEAR SENATOR NEUBERGER: Thank you very much for your courteous letter of recent date concerning the study of modern health screening methods to detect and prevent chronic disease in the elderly. The University of Texas South Texas Medical School is in a unique position to participate in such programs since it is a new school in its early developmental stages and is located in a community which has a high proportion of elderly medically indigent persons. Although there is no program in existence which meets these specifications, it is our desire to implement such a program at the earliest possible date. Through the cooperation of the Bexar County Hospital District hospitals, it will be possible to establish such a program in the near future with the cooperation of the various health agencies in the community. I will request Leon Cander, M.D., who is professor and chairman of the combined department of internal medicine and physiology at the medical school, to provide me with his opinions concerning details of this study and will be happy to communicate these to you at an early date. Please let me know if I may be of any specific assistance to you in this worthwhile project. Sincerely yours, F. C. PANNILL, M.D., Dean. THE UNIVERSITY OF TEXAS, OFFICE OF THE DEAN, San Antonio, Tex., September 21, 1966. Hon. MAURINE B. NEUBERGER, DEAR SENATOR NEUBERGER: As was promised in my letter to you on September 3, 1966, I should like to submit a little additional information to you concerning multiphasic health screening programs derived from consultation with Leon Cander, M.D., professor and chairman of the department of internal medicine and physiology. We both agree that the effective screening program should be aimed at pregnant women and individuals under the age of 16 in the initial phases. The schools, both public and private, could be utilized for the implementation of a program among children, and the pregnant women could be screened through a variety of existing health agencies. As the program is expanded to include other adults, every hospital in America should serve as a nucleus for health education which could then be dispersed into the community. A broad program of education should be undertaken initially to make use of the community and voluntary health agencies which now operate more or less independently of one another. Dr. Cander suggests that you contact Kendall Elsom, M.D. who is presently medical director of Scott Paper Co., International Airport, Philadelphia, Pa. Dr. Elsom has approached this problem from the standpoint of the industrial applications, but he does have a background which might be useful to your committee. Although this information is somewhat fragmentary, please be assured that the faculty of this medical school stands ready to assist you and your committee in any way possible. Sincerely yours, F. C. PANNILL, M.D., Dean. THE UNIVERSITY OF TEXAS-MEDICAL BRANCH, Hon. MAURINE B. NEUBERGER, Chairman, Subcommittee on Health of the Elderly, DEAR SENATOR NEUBERGER: I was pleased to learn from your letter of August 31, 1966, that your Subcommittee on Health of the Elderly is undertaking a study of modern health screening methods aimed at the early detection of chronic illness. Those of us in this department feel strongly that there is a place for multiphasic health screening programs in this country as an integral part of comprehensive health care. Furthermore, it is likely that such comprehensive screening methods will receive increasingly wider use within the coming years. This is a logical outgrowth of the increasingly prevalent attitude among our citizens of an entitlement to good health. It is clear from such automated centers now in operation that a rapid and accurate system of disease diagnosis can reduce the cost below that of conventional screening methods and at the same time make better use of the physician's time. As yet, we do not have an automated system of multiphasic screening in progress here. However, we would want such a plan to include individuals well below and above the age of 50. It would not be surprising if the medical profession was somewhat slow in accepting this type of screening program since time would be required to convince physicians of the timesaving potential of such systems. We hope it will be possible for you to keep us posted on developments related to your subcommittee activities. Sincerely yours, DON W. MICKS, Professor and Chairman, Department of Preventive Medicine and Public Health. |