And Now, Preventicare

"We have passed Medicare and Med-icaid," said Senator Maurine Neuberger last week. "But when do we turn the corner from treatment to prevention?

When will we maintain health as de votedly as we now fight disease?" In its effort to find answers, Senator Neuberger's Special Committee on Aging may be pointing the way toward the Federal Government's next national medical program. Its cumbersome and thus-far unfamiliar name: Preventicare.

The very idea is a product of the most modern medicine, which has made possible the detection and treatment of countless diseases before they display so much as a single symptom. The major problem is to get the symptomless patient to let doctors run the neces sary tests.

No Compromise. Witness after wit ness before the Neuberger committee testified that the most promising ap proach to Preventicare is called "multiphasic testing," a program that the California-based Kaiser Foundation Health Plan has been offering its mem bers ever since 1950.

The Kaiser multiphasic checkup con sists of 20 computer-oriented tests given by a team of technicians, nurses and machines. The patient arrives with a medical-history questionnaire already filled out. He picks up a clipboard full of IBM cards, strips to the waist, dons a paper hospital gown and takes off on his rounds. Pulse rate, blood pressure, lung capacity, breath rate and strength, reflexes, urine, eyesight and hearing, all get a quick but thorough going-over.

From a single two-milliliter sample of blood, eight blood-chemistry tests are done simultaneously in twelve minutes by an automated chemical analyzer.

Almost all the results are automatically coded for the IBM cards; the electro cardiogram and chest X ray, however, have to be read by human experts.

The entire examination takes only 21 hours for men, while women over 40 require a little more time because of an additional X ray for breast cancer.

Speed in no way compromises thor oughness. Dr. Morris Collen, coordina tor of the program, reports that fully half of the 40,000 patients seen annually have "clinically significant abnormali ties, conditions which the physicians will want to treat." Kaiser's cost is approx imately $25 per patient, and the health-plan members pay virtually nothing.

Multiphasic testing seems to be so ideally suited to mass preventive medi cine that a bill to start such a program nationally has already been introduced in the House and Senate. And at last week's committee discussion, hardly an opponent of multiphasics could be found. One of the few opposition wit nesses was Dr. Arthur Rappoport, a member of the board of the College of American Pathologists. Though he argued that the accuracy of multiphasic testing is still unproved, Rappoport later admitted favoring such a system "if the labs were run by pathologists."

If the mood of the committee and its witnesses is any indication, Preventicare and mass multiphasic testing will be accepted far more readily than Medicare. The costs, for one thing, would be less --a maximum of $1.1 billion yearly after the initial outlay for equipment v. a projected $3.5 billion in 1967 for Medicare. The U.S. Public Health Service already has plans for four experimental multiphasic labs, patterned after Kaiser's, in New Orleans, Milwaukee, Brooklyn and Providence. Said Dr. George James, dean of Manhattan's Mount Sinai School of Medicine: "People may some day begin taking as good care of themselves as they now do of their automobiles."

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