Automated Examinations

The logic is irrefutable: if a man has a thorough medical examination every year or so, doctors should be able to pick up the earliest signs of incipient disease or disability, and thus treat his condition most effectively and economically. But until recently, the omnibus "multiphasic health testing" approach was confined largely to corporate executives and high-echelon employees whose companies considered them valuable enough, in balance-sheet terms, to justify annual expenditures of $200 each or more for checkups. These screenings were performed by such organizations as New York City's Executive Health Examiners, serving the top brass of 400 companies, or the Greenbrier Clinic at White Sulphur Springs, W. Va., and could take several days.

Now, multiphasic testing is being made available to more people. The state of Rhode Island is running a federally financed program that costs only $40 per patient. Many large corporations are also offering the checkups to an increasing number of employees down through the ranks.

One man who is convinced that the value of periodic examinations is provable is Dr. Ernest L. Wynder, the first physician to produce firm evidence that cigarette smoking is a major cause of lung cancer, who is now a crusader for preventive medicine. As a director of the New York-based American Health Foundation, Wynder has persuaded six corporations* to finance the Health Maintenance Center, which opened early this month in mid-Manhattan. It is the last word not only in multiphasic testing but also in automation.

Any individual can make an appointment for a checkup at the Health Maintenance Center, but for the present, says Co-Director E. Stevens De-Clerque, the operation will rely mainly on employee groups contracted by their companies. First, the candidate must fill out a 378-item questionnaire on his own and his family's medical histories. That chore over, things are made as easy as possible for him. His questionnaire is fed into a computer. If the electronic brain finds inadequate or conflicting answers, it demands: "More data!" The computer prescribes the test schedule for each individual patient, based on age and sex.

After that, the process works like a luxurious assembly line. A technician takes blood and sends it to the adjacent laboratory for both blood-cell and chemistry readings. The results, along with those of urinalysis, are fed into the computer, which is programmed to rerun any tests that show questionable results. The electrocardiogram, usually elaborate, is also checked by the computer and can be double-checked if any abnormality appears.

At the end of an even hour for a man or 1 1/4 hours for a woman (because of additional breast and genital examinations), a physician at the end of the line has a printout of the full report. The center physician will send the report to the examinee's personal doctor or company medical department or provide him with a list of private physicians. If an examinee has a problem with smoking, nutrition (meaning, in most cases, overweight), high blood pressure or physical fitness, he can be referred immediately to one of four "intervention clinics" maintained on the floor below by the American Health Foundation. There he may be placed on special diets or exercise regimens, or helped to stop smoking through hypnosis or psychological support. "When the center detects a health risk factor," says Wynder, "we like to intervene immediately. We don't want to lose patients--we want to get them while they're hot." Eventually, Wynder hopes, there will be a dozen or more such examination centers across the U.S.

*Five of the companies are Control Data Corp., Eastman Kodak Co., Northwestern Mutual Life Insurance Co., Norton Simon Inc. and Time Inc.; each has an 18% interest. The sixth, Bradford Computer & Systems Inc., has 5%. The remaining 5% of capital was donated by the six corporations.

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