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In This Issue: Pages CHD Intervention Trial Begins ................ ........ ..........1 _ , .. .. _... 3 More About Health Maintenance.......... AHF Statement on HMOs ..................... 5 Ten Rules for Good Health ........ .:. _ .. ...........7 New Journal Wins Acclaim ........_ . ....•8 Vol. 4/No. 2• Publish~d for the Advancement of Preventive Medicine • October 1972 AIIF Trustees Appoint Dr. Edmund D. Pellegrino New Chairman for Scientific Consultants Board Edmund D. Pellegrino, M.D. and head of the Health Sciences Center for State University of New York at Stony Brook, has accepted an appointment to serve The American Health Founda- tion as chairman of its 16-member Board of Scientific Consultants. The announcement was made jointly by William J. Levitt, chairman of AHF's Board of Trustees, and Dr. Ernest L..- Wynder, president of the Found- ation. Dr. Pellegrino succeeds D.. Pellegrino Dr. George James, dean of The Mount Sinai School of Medicine, who died last March. Dr. James had held this post since AHF was founded in 1968 as the first non-profit organi- zation devoted solely to preventive medicine. Role of Chairman: It is through the Board of Scientific Consultants (see membership listing on P.21 that AHF plans its many medical research and public education programs. reviews the progress of current projects, and formalizes its position on critical health maintenance issues. Dr. Pellegrino, as chairman, will be responsible for recommending new research programs and helping to coordinate the various committees into which AHF's consultants are now organized. , "This is one of the most important positions that our Foundation can offer." said Dr. N'ynder. "and we are extremely pleased that Dr. Pellegrino is joining our Board. He is an outstanding scientist, distinguished in many fields, and will be a great asset to our work in preventive medicine." Professional Background: Last spring, Dr. Pellegrino was being sought by the Administration to assume the position of assistant secretary for health and scientific affairs in the Dept. of Health, Education, and Welfare. Because of the severe fiscal crisis in the State Univer- sity of New York, which imperiled the development of the Health Sciences Center he is heading at Stony Brook, Dr. Pellegrino and HE"' Secretary Richardson agreed to discontinue the discussions. Dr. Pellegrino has been at Stony Brook since 1966. There he has served as vice president and director of the Health Sciences Center, dean of the school of ined- icine, and professor of inedicine. Other positions held earlier in his career include: chief of inedical-service, army air force regional hospital, Montgomery, Ala.: director of internal medicine and medical director. Hunterdon Medical Center, Flemington. NJ.; profes sor and chairman, department of medicine, University of Kentucky Medical Center. After receiving his M.D. from 1ew York Uni.'ersity in 1944, Dr. Pellegrino interned at Bellevue Hospital and completed residency at Goldwater Memorial Hospital, both in New York City. He holds four honorary degrees, and is a fellow or member of more than 20 scientific, professional. and honorary societies. Dr. Pellegrino has authored some 200 articles on sciem tific research. medical education, and philosophy. He also is a member of the editorial board of several scien- tific journals. His current research interests are in the fields of calcium metabolism, physiology, and chem istry of calcified tissues. AHF Participating in NH1.1 Inter.entiun Trial For the Pre.ention of Corunary Heart 1)isease A contract awarding $385,990 to The American Health Foundation has been received from the National Heart & Lung Institute. It was granted to authorize and un- derwrite AHF's participation in the first year of a new six-year research project called the "Multiple Risk Fac- tor Intervention Trial for Prevention of Coronary Heart Disease." AHF is one of eight medical research centers around -the U.S. which, along with a coordinating center, were enlisted by NHLI to initiate this large-scale interven tion trial. Ultimately, an additional 12 centers will parti- cipate in this joint effort to determine the exact role of each high risk factor in the development and prevention of coronary heart disease. Directing the AHF research team on this project will be Dr. Ernest L. Wynder, principal investigator, and Dr. Peter B. Peacock, project director. Dr. Peter Hill of the AHF Health Research Institute will head a group responsible for blood chemistry determinations, which includes specialists in the following health care areas: Donald T. Fredrickson, M.D., smoking cessation; Herbert Spiegel. M.D., behavioral aspects; Mrs. Jane Baldwin, M.S., nutrition; and Richard P. Ames, M.D., hypertension. J

The American Health Foundation Newsletter New Chief of Epid emioloK~ Di~isiun Announeed The American Health Foundation, Inc. EDITORIAL BOARD The appointment of Peter B. Peacock, M.D and D.P.H., as chief of the division of epidemiology in the AHF 1370 Avenue of the Americas New York, N Y. 10019 ~~~L ~~~~~o~f Health Research Institute has been announced by The (212) 489-8700 Dap~Jrnes Eml« American Health Foundation's board of tnstee_s. Dr. - Peacock joined AH-F on Septem- ber 1 after servin rofe sor as OFFICERS AND BOARD OF TRUSTEES , g p s and chairman, department of pub- %G Pr d t E t W M D lic health and epidemiology, at - pl en rrbs yr L Wer '~a the University of Alabama blcdi Cnmrman Wllram ) Levrtt viceCna;man _ G Wil1am. MGOre ..~ cal Center in Birmingham-since Founoer and Boaro Charman Boaro Cna,rman 196i. During his tenure there. he ~ LevmanaSoos Inc F,eldcrestMels.Inc - _3; . also was in chargv of public health Secretary. HupoJ Gerardin - Treasurer Warner0 d- ro~e Jr ~~ ~ programs at the Schools of Op- Part^er Loeo Rhoaoee d Co g Mana9 9 Partner la Sn & C Dr. Peacock tometry, Dentistry, and Commu- . ompany .e s nity and Allied Health Resources F/on«aryCnairman DavrdJ Mahoney CllirmananCPtesWent.NortonSrmwtlnc In addition to being a member of three National Ad- visory Committees (stroke epidemiology, cancer epi demiology. and bio-radiation effectsl and the National TRUSTEES Board of Health Examiners, he has served as project Lour) V Aronson II Pr nl John H Miichell - director or consultant on various state health programs es,ae Ro^son Corpora2ron PreS~dent Screen Gem s - , nd was regional director for Third National Cancer Julrun Cann Survey'. Presrdenl JosephM Murtha - Famrly Heanh Commun,c~nons Pres~oenl -sana9renaM,,rrna Inc Born in Kenya, South Africa, Dr. Peacock graduated Mrs CnanesA Dana jbf.B. and Ch.B.) from the University of Cape Toµn in Ralon uarMau Sc D - V~ce P es~ae~ey 1945. He later received seven advanced de rre•cs from HLCOnInternanonailrX E F HutronaCplnC various universities in South Africa. England. Canada, Edv.2rdH Meyer . Ma.wellM RaDO and the U.S. DI\'ldmg his career mostly between medi Premdent Panner cal officer positions (S. Africa and Canadal and uni Grey Advert.vnq rnc _ Sncock d Stroock A Lavan versity appointments (S. Africa, Canada. and U-S.) he is a freauent lecturer, has authored numerous mcHli eal and scientific papers, and contributes extenaively to BOARDOFSCIENTFICCONSULTANTS epidemiological research in many fic•lds. Char - Marv n Kuschner M D EomunoD Ppllepnnp MD v~ceP•esraenr ProfessoraCna~~rnan DeoartmenrorParholoey Dr. Peacock, now a naturalized citizen of the U.S., is HeaanSaencesCente. Stateun,~en,ryorNer.York HeannSoencesCenter slateur.~ers.tyofNewr«k certified by both the American and Canadian boards in atSronyBrook atStonyBrook public health. Among many other professional affili- ations, he is a member of the American Canadian and La.r.enceBergne. M D DrrerororHeam G E L:.nngston Ph D_ P,oressoraneDreclor . , S. African public health and medical associations, a seame-KrnaCor,nh DepartmenrofP„a,cHeanh FooasaencePro9ram InsirtweolH~m,anN„mnon . FellowoftheRoyalCollegeofPh sicians(C'anadaland y' car,maaunn,ersrty the Royal Society of Tropical biedicine and Hygiene LesterHresbw M D M P H Cha.rman De artm l tP . and is listed in Who's Who in America In his new isi- f en revenl,ve c o andSoaalMearcrne GottnardScnettler M D Profe:.,orofMee,ne tion at AHF, his responsibilities will include serving as Schoolof Meorine Unners,tyorCaiA«nlaatLOaAnqeles Uni~ersr^+or Heroe~berg project director of a largescale coronary he•arl disease Morton K Schwartt Ph D study (see P 1/ now being organizcd. Jonn Cassel M D M P H _ PRpteSSa and Heao Charman Department of Biochemistry MemCrial HoS~~!al or Cancer Department of Eproemrdopy _ Scrxwor of Pubec Hemm and All~eo Disea.sea - ' Un,~ers,ty of Nonh Carolrra Pr,rl,~ sn„ak M o 1~eN AHF Cigarette Study furl;SDA Nov, F'nders+a) Drrecl« Tne Epo~ey Institut6 Rene J Duhrn Pn D ProfessorTheRockefellerUnrverlty 1w Researcn .n Cancer Uni'+ersrtyofNebrasnaMetlicalCenter A contract to relme existing analytical techniques for the quantitative determination of traces of carcinogenic W~II,am L Evers Ph D Cons,ntant Heroert 5tregel M D DecartmentnfPSycn,arry introsamines in cigarette smoke has been aMarded to forUnrvervtyResourcas eowmaaUnryeary The American Health Foundation by the U.S. Dept of AlvrnH Fre~man MD FreCnckJ S1are MD PhD Agriculture. The procedure developed will be applied Cnrer or'sr«+orMec.calsntems ena~,man.Deoartr-,enroaN,m.non to 32 different cigarette brands, thus assuring.a com Mem«al Hwaral for Cancer - udAUreeD~seasaa Flarvard unive•vry schoolaP„ry,cHealtn prehensive study of the various tobaccos used in the manufacture of blended cigarettes available on the mar- Takesnr H~rayama M D Theodore B Van ttall~e M D k t C d puer EDrtlem~~yoqy Drvrlron - Drrector of Meo~rne e O a y. Japanese Nanonal Can~er Center St L,ke s Hosptal Center AHF's principal investigator on this project is Dietrich Hoffmann,-Ph.D., chief of the Environmental Carcino PUOlehedbyTheAmencanHeanhFOU ndatronlnc arornorofrt taa genesis Division. Funding of $25,011 is provided for s ama c«noranon Eadeo t« rna,st nal em,canonal comm„nrca- in the contract received from the Crops Research Di - no.., qo emmanr ana mearw eaaers AbW are n rt t f conce eo tn neann ca.a vision of USDA. i v o raw,nt e0 rom tnia intheFpurtCanon PleaSeforwaroad« newsletter Ireey wrtn creait ess[narq¢3IoTnCAmerican Healtn Founoahon 1370 Averwe of the Art,errces New york. N V 1t1019 - I

AHF MoN-in~ to Forefront in Health l~Iaintenance Field Something had to be done to improve the delivery of health care and, after a decade or more of claims and counterclaims, the U.S. now seems ready to accept the Health Maintenance Organization (HMO) concept as a viable and visionary soiution_to problems which many had feared were insurmountable. each service rendered. More than 40,000 physicians are now in group practice against 15,000 in 1959. - • Health Care Provider: a HMO, Health Care Corp., hospital or other institution, physician group, etc., providing health care services. Three major bills have already been introduced in Con- gress, each proposing the development of organized medical practices through HMO's. More than 110 grants have been made-via HEA'-for the funding of HMOs across the nation. An Administration goal of making HMOs available to 90S'o of the U.S. population by 1980 was announced. Although the Congressional committees considering HMO legislation are controlled by Democrats. biparti- san support is evident. Senator Richard S. Schweiker (R Pa.l recently spoke for many Republicans in Con- gress in saying: "That HMOs are needed in the health care delivery sys- tem of the future is a foregone conclusion. Changes are needed...but our existing system does not need to be replaced lock, stock, and barrel. Significant improve- ment will occur if a real alternative is introduced. The concept of the HMO is the real alternative." Resistance Fading: While the resistance once prevalent has given way to respectability, HS1Os have not yet achieved reverence. Demonstrations that HMOs can be operated with minimal federal assistance are much needed. The role of HMOs in a pluralistic system of health care delivery requires better definition. Con- sumer understanding of HMO services and objectives is still inadequate. Senator Schweiker has raised another troublesome question: "The real issue is whether HMOs should be the exclusive component in the health care system, or should we allow more flexibility to encompass the pre- paid group practice, as well as the medical care foun- dations"" Learn the Language: For those not familiar with the distinctive terminology being spawned by HMO ad- vocates, a series of articles written last summer by Sylvia Porter, nationally-syndicated newspaper colum- nist, were most helpful. After stating. "The HMO is becoming the hottest part of an emerging new era of health care." Miss Porter urged readers to remember these key terms: • Comprehensive Health Care: generally includes, both in and out of hospital, preventive, primary, specialty, restorative and extended care. The whole works. • Group Practice: practice by a group of physicians, typically six; some groups are highly specialized, others cover a variety of specialties. Traditional is a fee for • Health Cooperative: group practice plan involving prepayment for a full set of services and also ownership of the plan by the subscribers who supervise the plan. • Health Maintenance Organizations: typically prepaid group practices with dual goals of comprehensive continuous health care and more health care per dollar and with stress on early disease detection and prevention. Some 8-million Americans now enrolled, getting high quality care at cost as much as one third lower than traditional forms. • Multiphasic Screening: battery of tests and exams to determine person's state of health and detect signs of illness. Tests usually performed by specialists in lab work, not doctors. • Peer Review: continuing evaluation by medical staff of a HMO, hospital, group practice, etc., of quality of care being given by all providers involved and of appro- priateness of the services for a patient's best interests. In a subsequent column about HMOs, Miss Porter wrote: "typical cost range for a family is $35 to $60 a month. Normally included are full. comprehensive ser- vices with strong emphasis on preventive care as op- posed to "crisis care." Because of this. HMO members tend to go to hospitals less frequently and get out faster." Recommended Reading: If everything you've always wanted to know about HMOs can't be found in news- paper or magazine articles, a reading of The proposed Health Maintenance Act of 1972 will fill in most of the gaps. Written by Congressman William R. Roy, M.D., and published 1$13.501 by The Science & Health Com- munications Group, Inc., 1730 Rhode Island Ave., Washington, D.C. 20036, this 3G'rJpage sourcebook provides a comprehensive introduction to HMOs for laymen and health professionals alike. In this excellent book, the only one yet published on HMOs, Congressman Roy ID-Ran.l presents the text of major HMO legislative proposals now before Con- gress, reviews arguments for and against them, draws a systematic analysis of issues involved, and offers sug- gested solutions. Of special interest to readers are sec- tions dealing with positions on HMOs taken by the Nixon Administration, American Medical Association, American Hospital Association, AFL-CIO, Associa- tion of American Medical Colleges, and many other key health care organizations. From an opening review of_ existing U.S. health care problems to the financial con- fContinued P 41 L-I

+`COMPUTER SYSTEM used in automated multiphasic 'health screening is explained to Dr. Hollis S. Ingraham (right), N.Y. State Commissionerof Health, by Steuens / de Clerqae, president of American Health Corporation. The two men are shown before a computer terminalstation during recent tonr of facilities at the Health Maintenance -Center, n•hickofficially opened on June 12 and is nom being jointly operated by American Health Corporation and The American Health Foundation. - siderations he concludes with, the author has clearlv and precisely stated the case for HMOs as the emerging delivery system for health services. The HMO at AHF: Our own American Health Founda- tion has, of course, done much to pioneer the H V O con- cept. As the first nonprofit organization devoted solely to preventive medicine. AHF has long advocated such good health practices as regular medical checkups, cessation or moderation of smoking and drinking habits, proper nutrition, physical fitness, and numerous other disease prevention strategies. Earlier this year, more- over, AHF moved directly into the forefront of HD1O developments by announcing: - 11 The opening in April of our Health Maintenance in- stitute, a public service facility comprised of four "in- tervention" clinics where people can come and leam how to stop smoking, reduce and control weight and hy- perlipidemia, reduce and control hypertension, and de- velop general physical fitness. 2) The opening in July of The Health Maintenance Cen- ter, a joint facility of AHF and The American Health Corporation. Here the preventive approach to health maintenance is practiced through automated multi- phasic health testing IA`v1HTi. This Center will serve as the prototype for AMHT programs which will be established later in many other locations. How AbiHT Works: "The logic is irrefutable," said Time magazine (7/31/72) shortly after our new Center began operations. "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 dis- ability, and thus treat his condition most effectively and 4 economically. But until recently, the omnibus 'multi- phasic 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. 4 . k"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 pa- tient. Many large corporations are also offering the t 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 multi- phasic 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 DeClerque, the operation - will rely mainly on employee groups contracted by their companies. First, the candidate must fill out a 378-ite•m questionnaire on his own and his family's medical his tor'es. That chore over, things are made as easy as pos- sible for him. His questionnaire is fed into a computer.- If the electronic brain finds inadequate or conflicting answers, it demands: 'More data" The computer pre- scribes the test schedule for each individual patient, based on age and sex. "After that, the process works like a luxurious assembly Gne. A technician takes blood and sends it to the adjacent laboratory for both blood-cell and chemistry read- ings. The results, along eith those of urinanalysis, 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 14l hours for a woman /because of additional breast and genital ex aminationsl, a physician at the end of the line has a print-out of the full report. The cer.ter 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 examine•e has a proble•m with smoking, nutrition Imeaning, in most cases, over- weightl, 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. 'When the Center detects a health risk factor,' says R'ynder.'we like to intervene immedi ately. We don t want to lose patients-we want to get them while they're still hot.' Eventually, Wynder hopes, there will bea dozen or more such examination centers across the U.S."

% Statement on HSIOs at Congressional Hearings by Ernest L. Wynder, M.D., President of AHF May16, 1972,/orHvuseojRepresentatiues CommiYtee on Interstate & Foreign Commerce One of the obligatory-let me stress "obligatory"- components of any HMO that should be considered ih any legislation proposed is the provision, and the appro- priate incentive, for measures that can contribute to the prevention of disease and disability. - Disease prevention falls into two categories: primary and secondary prevention. Primary prevention relates to the reduction of risk factors at a time when disease is not detectable-either clinically or, at times, on a cellular basis. Secondary prevention relates to the early detection of-disease: The H11O must take responsibiGty in both areas, the detection and the appropriate re- medial measures. , •. . 'J - . , . . . . , How to Begin: HMOs should start off by establishing a health profile on each of their members. This country possesses the technical ability to undertake such a profile on all-I emphasize "all" -Americans and repeat them at regular intervals. HMO programs or associated federal tax reforms should offer incentives for the cor- rection of high-risk factors, and besides the treatment of symptomatic illness, should include clinics to help people who have problems in excessive smoking, mal- nutrition, hspertension. alcoholism, drug abuse, and physical fitness to reduce these high risk problems. All of this would put the emphasis on primary disease prevention.- ' - -. Since all of us have difficulty in relating today's bad habits with our health status 20 or 30 years in the future, it is also incumbent on us to modify hazardous products nos. For example, we need measures to estab- lish less harmful smoking products. Food products can be modified-to be healthier for all society, for the affluent as well as the impoverished. And we need to strive for safer highways and stricter law enforcement against the drunken driver. Incentives to Motivate: We have learned much in re- cent years about the natural history of diseases, as well f CHOLESTEROL tso LEVELS . uMer 175 2W 250 175 b b b 20 o 225 - . 275 NewsweeM 5/1/72 as about therapeutic measures. Our health insurance organizations at present place almost exclusive empha- sis on therapy. The natural history of most common illnesses and disability suggest that emphasis on ther- apy alone is both economically and medically the poor- est way of utilizing our resources. While future HMOs obviously need to be well staffed and experienced in therapy, we urge that they give proper emphasis to pre- vention of disease and disability, both through their expertise and by offering appropriate incentives. The German insurance system, one of the oldest in the world, has recently given an incentive to early detec- tion of cancer by reimbursing the physician for examin- ations to detect cancer of the cervix and breast and for cancer of the prostate and large bowel. Whatever HMO system is proposed in this country, it should advocate no less. In fact, any American health insurance system should provide appropriate incentives to motivate phy- sician and patient-alike toward preventivG health _ practices. r y? HMOs so conceived will contribute to reducing avoid- able disease and disability and, simultaneously, will free medical professionals for the treatment of diseases which are not avoidable at present. In this way, HMOs also offer us a real chance of saving resources that can be put to brtter advantage for the pursuit of happiness and the health of our society. Much to Gain: Our current knowledge of disease and disability-indicates that we can be successful in this endeavor. The early detection of cancer is a case in point. Such programs have been successful against certain types of cancer, notably cervix, breast and large bowel, but have proved relati%ely unsuccessful for cancers such as lung, pancreas, and stomach. Similarly, hypertension is a disease which, if treated early, has been shown to reduce the-risk for stroke and congestive heart failure. If detected and treated still earlier in life, it is likely to reduce the risk for heart attacks as well. Yet, in the U.S., some 5(K9o of us have never had our blood pressure measured, and when chc-eked and found elevated, only about 20% of the cases were properly Three Major Coronary Risk_ Factors p , p p .150 BLOOD . -!sa - PRESSURE SMOKING HABITS , (Diastolic) - ,oo Do - 11 .50 111 I 275 300 uMn 75 as n 105 Mem Nst r,P. „ nr.rr tr«1, ar. b rd r5 b b b rd Smu4E On1r CKx r ln, pn Dq I rM 300 a.er rrs >s 105 aN 0.11 rn Dq /n Drr Mwc.'. MhTipNAI NEMT u+D lur.C,,MST,iUrE (Continued P 6) 0 ulation Rates of first heart attack er 1 000 of male o

GUEST OF HONOR at tuncheon held to announce the opening of ANF's four new Health Maintenance Clinics was Congressman Paul G. Rogers tD-Fta./, chairman of the House Subcommittee on Public Health and Enoiron- ment. Shown here on tour of new facilities with Dr. Ernest L. Wynder, president of AHF, Congressman Rogers told those attending the luncheon: "I think that Congress is going to write more preuentiue medicine concepts into law, "and he predicted the fLS would see a great increase in health maintenance organizations by 1975. NMO Statement (Cont.) treated. In view of our inability to treat effectively many stroke victims-because of catastrophic health insurance rates: and because of the established role of hypertension, myocardial infarction, and other cardio- vascular diseases-it is imperative we improve our techniques for the early identification of high blood pressure and its therapy'. Much to Remember: As my friends know, I enjoy read- ing about the history of medicine. What we talk about here has been talked about by physicians for centuries. For instance, in 1653, Thomas Adams wrote: "Hee is a better Physician that keepes diseases off us, than he that cures them being on us. Prevention is so much better than healing, because it saves the labour of being sick." The concept of disease prevention is also well expressed in a Greek adage which has become the motto of The American Health Foundation: "It should be the func- tion of medicine to help people to die young as late as possible." In the 1970's, we should have the ability in this coun- try to make these ancient sayings a reality. With the help of the medical profession. allied health professiom als, the health insurance industry, society as a w'hole, and above all with the help of the Congress, we should succeed in making diseaseprevention the first step in our health care delivery system-and thus make us a healthier nation. A well-designed- and well-conducted HSIO in which meaningful preventive services must play an integral part will contribute much to accom- plishing this goal. (In the discussion period follouing his statement, Dr. Wynder answered a number of que.stions about HMOs which will of interest to our readers.) Question : I wonder if you would address yourself to the economics of preventive medical practices with regard to annual examinations and multiphasic screening and so forth? Dr. Wynder: As you may know, we are establishing in New- York Citv a health maintenance center which is fully automated and computerized and which, together largely with allied health professionals, can do a mean ingful health screening in one hour and have all results available for the physician's examination at the end of the hour. By utilizing all of this technclogy, we can con duct health screening on a massive basis in a relatively inexpensive fashion. I cannot tell you what the system will cost once it is fully in operation. Even in this earls demonstration period, it w'ill cost not more than Sb5 per person. I would suggest that the cost on a mass basis, once it is dupli- eated from city to cit_v and from center to center, will be much less, even as little as $50. - Let me emphasize that a HMO that does health scriKming without the appropriate inter:ention would be wasteful. The intervention must be an integral part of the identification of these risk factors. Question: As outlined by legislation Ix•fore us, is the concept of HMOs a viable form of a comprehensive dr livery system of health care7 Are you completely in favor of the Congruss progress in the direction that we have gone in creating H\lOs'.' ` Dr. Wynder: I am-now speaking as an individual, be- cause I have not reviewed this with our scientific board. As an individual, I favor the concept of the HStO- In fact, in most hospitals we do already have some kind of group practice simply because medical knowiedge has become so complicated that there are very few physi- cians who are so wise that they can fully comprehend all existing medical knowledge. Beyond that, I favor the H!t7O concept because only in that way can we cover the whole range from prevention to therapy. The H!t1o should say', "Your health is my obligation." I said your health, not your disease prob- lem. HS1Os should incorporate the incentive to ktrpyou well, to keep you out of the hospital and to save you money, because money saved by you is money saved by the country. The H1fO concept, provided it is human ized and is well integrated in our total medical care de livery system, is a viable way in which curative medi- cine and preventive medicine can be practiced in this country. Question: Do you see HAfOs being sucessful in the rural and ghetto areas? Dr. R'ynder:Obviously, if we are for H!.1Os and for ad vancing the health of the country, we must include all socio-economic components of the country. But when we /Continued P H) 17

NCI Grant Extends Range of AI1F Cancer Studies Funded with a new award of $312,908 from the National Cancer Institute, research into_four additional areas of environmental carcinogenesis is now being conducted by investigators from The American Health Foundation. Major areas of the NCI project are: • Epidemiological investigations of cancers of the kid- ney, large bowel, breast, and gynecological sites. • A program concerned with the metabolic epidem- iology of mammary cancer. • Studies dealing with the biological effect of dietary fat on rat tumor development.' • Quantitative analysis of insecticides in adipose tissue, and the role of smegma in carcinogenesis. - AHF .Awarded Air Pollution Study Grant by EPA The American Health Foundation has recently received a one-year research grant from the C.S. Environmental Protection Agency. Funded at $38,735 and covering the period from 5/1/72 to 4/30/73, the objective is to develop a method for the profile analysis of carcinogenic polynuclear aromatic hydrocarbons in polluted urban air. Principal investigator on the EPA project is Die- trich Hoffmann, Ph.D., chief of AHF's Division of Environmental Carcinogenesis. SHARING HOtiORS for their world renowned work in identifying high risk factors that lead to heart disease are Dr. Thomas R. Dawberlrightl and Dr. William B. Kannel (left), directorand deputy director of the Framingham Heart Study, who were recently named co-recipients of AHF's firs t annual Eleanor Naylor Dana Award. With them is WiAiam J. Leoitt, chairman of AHF's board of trustees, holding one of the awards presented in recognition of theirdistinguished contributions to preuen- tiue medicine. OBVIOUSLY DELIGHTED at learning AHF's first Life Line Award had been bestowed on the National Football League is NFL Commissioner Pete Rozelle tlvftl. Shown with him are Sfrs. Milton Rackmill, co-chairman of the award luncheon. and David J. Mahoney, rhairman of the board and president of Norton Simon /ncc and honorary chairman of AHF, uh.o presented the auward to Mr. Rozelle. The auard was given forparticipation by NFL and its players in a national TV campaign to curb drug abuse among the nation's youth. AFIF Proposes Ten Golden Rules for Good Heafth As a basic element of its national health education campaign, The American Health Foundation recently formulated a list of "Ten Golden Rules for Good Health " Brief and easy to remember, each rule is a kind of trig- gering mechanism, designed to encourage, motivate, and focus attention on highly desirable health mairr tenance practices. The rules are: I) Have a check-up every year. 2) Be a non-smoker. 3) Drink in moderation. 4) Count each calorie. 5) Watch your cholesterol. 6) Learn nutritional values. 7) Find the time for leisure and vacations. 8) Adjust to life's daily pressures. 9) Develop an exercise program. 10) Understand your physical assets and limitations. Through repetition in various media and literature, AHF believes that its 76n Golden Rules can contribute to the general public awareness of what preventive medicine is all about. AHF began distribution of_ the new health rules last spring when - printed on cards and inserted in plastic cubes-they were given as souvenirs to guests attending the Eleanor Naylor Dana Awards luncheon. 7

ConKressional Attention for Vea AHF Journal For those who may have seen either of the first two issues of Preventive Medicine, AHF's new quarterly journal, and those who will be reading it for years to come, we are happy to report that the initial response has been gratifying beyond all expectations. In fact, somewhere in the musty volumes that record what transpires at Congressional health hearings, the following dialogue Idatelined May 16, 1972) has been preserved for posterity: Hon. Paul G. Rogers: "I think it' would be well to note for our committee that The American Health Founda- tion now is responsible for publishing the first journal on preventive medicine. Dr. N'ynder, I think I see a copy of it with you, do I not?" Dr. Ernest L. Wynder: "Yes, you do. The main ob)oews,r tive of this new Journal is to try to educate physici3ns, in the practical application of disease prevention. IBr .. would like to tell our medical colleagues that to pre- ,_ vent disease is to treat it. This is a difficult thing for a physician to get excited about, particularly because disease prevention only happens over a period of years. "It should be the function of the physician to identify the risk factors early in life, and to reduce them as early in life as possible. This nation cannot afford to treat all of these unnecessary illnesses. not only because of economic costs but because many illnesses are not cur- able once they have de%eloped." JAMA Likes It, too: Among many others to comment favorably about our new magazine was the Journal of the American Medical Association_ In its "editorials" page. JAMA said: "Precentice Medicine is off to an excellent start.... To Dr. Wynder and The American Health Foundation, The Journal extends greetings and ,o0"' best wishes for continued success with an outstanding publication." - The American Health Foundation, Inc. 1370 Avenue of the Americas- New York, N.Y. 10019 AMONG THOSE ATTENll11G presentation ceremonies for the first annuaf EleanorR'aytor Dana Amard mere Mrs. _ Dana (second from-right/ and /L-to-R/ Mrs. John Bruce, Mrs. G. William Moore, and MacLean Gander, president of The Charles A. Dana Foundation, Fnr. Mrs. Dana is a member of AHF's board of trustees, and the amard ginen Rp.,J~ her name is for honoring "the most signifi<ant conbi- utions"to the field of preoantiue medirine.- HMO .Statemen t tCont. / speak of health, it probably means one thing to the edu- cated individual. and another thing to someone who is impoverished. If you go into a poor community and you speak about health care, that is the least of the problems they have. They are fir,t concerned alxiut malnutrition, and they are concerned about overcroNding and its effects. We ha,e to realize that xhate.er HS10 we ha%e, for certain populations it is not sufficient. We have to Itxtk at disease prevention from the vieNpoint of the whr,le society, and recognize that there are certain diseases re- lated to malnutrition or to poor housing, and these issues also ha e to be our concern if we want to elimi nate unnecessary illnesses in the U.S. . Non-Profit Orp U. S Poste9e PAID New York, N V. Pe-t No. 5297 Alex W. Sp=ar3, Ph.D. P. Lcrt::ard Ccmpany 2525 Eazt '-'arze: S`.. Cracns t:r o, li. Car. 27420 a--