Tobacco Documents Online

-4- Reading an A~erican magazine recently, I cane across a state=ent about what is happening in Canada. It is a little long, but %-orth quoting: "Exiled from TV screens in the United States, cigarette advertising now faces the ultimate prohibition in Canada. Last week, the Government in Ottawa introduced a bill that ~uld end all cigarette ads in that country beginning next January 1. The bill is certain to pass. The ban will go beyond broadcasting, to embrace Canadian newspapers, magazines and bill boards. In addition, each cigarette package would have to carry the tar and nicotine level of its contents and the admonition 'Warning: Danger to health increases with amount smoked. Avoid inhaling'. Every cigarette must have a ring printed around it near the middle to caution the ~moker that if he puffs beyond that point he will get increased concentrations of tar and nicotine. The proposal would also give the Government authority to set standards to tar and nicotine content. As a result, say industry officials, the expected strict requirements could make Canadian cigarettes tasteless and encourage boot-legged imports from the United States. For all their complaints, tobacco men are highly unlikely to violate the law. Anyone who does will face a maximum fine of $1OO,000 or five years in jail, or both." Canada. is well ahead of any other country. America is not doing badly. There has been a considerable fall in smoking in the United States, and since 1964 they have had a warning notice on cigarette packets which has recently been strengthened. The smoking of cigarettes in England dropped 13% following the issue of the report by the Royal College of Physicians but I am reliably informed that it is creeping up again and that we have really got to do something about it. The Government has arranged with the tobacco manufacturers to put a notice on cigarette packets, a rather feeble notice I think: '~arning by Her Majesty's Government: Smoking can damage your health". I doubt whether that is going to stop people smoking 30 cigarettes a day. I should like to see a preferential tax on pipes and cigars to get people weaned from cigarettes. In New York, there was a proposal for a tar and nicotine tax, a tax per pack of cigarettes depending on the contents. Following the issuing of the Report of the Royal College of Physicians, we had a meeting and launched a body which is called '~otion on Smoking and Health", and the letters of that, curiously enough, spell the word ASH, and ASH is now beginning to make itself felt. We tried to bring together all the bodies concerned in stopping the holocaust from smoking: medical organizations, teachers' associations, parents' associations, students, The British Medical STudents' Association and the National Union of Students, boys' club leaders, women's Insti~tes~ leading newspapers, and so on. ASH is already bringing out a regular newsletter~ it is becoming a centre for information and a place which will stlmulate action. It has contacted the BBC and the commercial television, trying to stop them a11owing people to smoke on the screen. Public transport in England has responded remarkably well. The London Passenger Transport Board are increasing their non-smoking compartments up to 709 and they are stopping any smoking on single-deck buses. British Transport is also increasing its non- smoking compartments. One form of transport which remains resistant is the airlines, on which the stewards still come round offering cigarettes. Photos available on request from Phot6 Unit, Division of Public Infor=ation, World Health Organization, Avenue Appia, 1211 Geneva 27. TI09782564

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NEW YORK, N.Y. NEWS D. 1,606,365-S. 2,237,494 NEW YORK CITY METRQPOLITAH AREA ./,PR 7 1981 J.III i I1 II I li I 1 II I L I [ I I Ill • '~:.7." ",= Ill mill Cancer Don'tletdiagn0Sis " ....... paralyze Isadore ~se~eld, M,~.~ Is ~ card~olo#Ist =ad .... " ~ " ,,,i, ~ Cancer Society ~dt~Iths~ndl'ng, I there/Ore advise', . of tobacco from o~r soclety,..by the~-Way~'would also Is • consult~n# ~o ~he N~tional Insli~utes o~ liealth ~nd,the author of a highly re~arded earlier ~ 8igh~i~anUy reduce the incide~ee ot this dredd . afflictio..) ' book, "The CompIe~e MedlcM Exam." , ' P?~lem ~. You ar~ told you h~vc ~ancvr of'the • . " - , ~~( ~ , • ~..~ . ~ . "~'~v~ ~nd that It is too late for ~utgc~ ~c~0~e the By DR. ISADORE ROSEN FELD ~ ~ ~. '" [ } ~ [ ~ I~'~ ~;~td~c~r aJready h~S ~read, " . ,s~,s,,z,, "~. ~~ ~" - ~ ~S Ss SV~ m ,~ Ask fo~ a secbnd opinion, Ovarian cancer do~ not ~ ~0U HAVE BEEN TOLD you have cancer It / • ' ' , ~ ~,~'~ respond as w~l~.~atment as can~r.~f th~ ~s, may have b~n foun~ in'a routine physi;al, . ..... ~ = ~-'-' --~r-' ' ~-~' Th~ p~tle?[ uSV~.lmprb~es ), a.y~pr or t~, b,t !~ rromem ~ ~strogens nezp cent u~ yuur m ...... " " not ~red heSr~ a~ Often ~s m uterine malignancy, m m a,cnest ~-ray, aurmg a pfoctoscopy or in a: • " - "- =" "~ ~ bh~ ~bu are' told to s~" ~ ....... " - ' .- ~ • ~1~ *~* B~f~e &n~th~- else ~ou must have the . menopausat no~ tms~e~, ~ .y • . ~ -the best Chance 1i~$ lfl complete surgical rem6~aL :~ ~i~o~"co~#~ ~othe~expe~ Here are .?.them bec~se ~eyqan ~use.ut~ne ~an~er~ ~,. '. "::~ven ff the tumor has spread, the.$ur~e~fl sh0uld '~ " The evidence lt~king 'estrdgens to SUCh cancer till r ' some typical issued you might then face: ~ ':} "' ln'~e~ Still ~m~n~ the 4~.~ cadeer s . emo~ aS ,~uc~'.eb ~ossible. T~l~ ......... ' .... : cannot ~ g • . , p. g , . .su~se~eflttreatment i$d program oz ~nemoth~rapy rromem z. A rump has ~en zounu m your vreas~ ~... .... ~ -,ear in ~e ;~lted S~te~ Only 3 3~ ............ ~ , . ~: ........ ' , The surgeon wan~ you to agree in advance to let him r~suZt~om~ance~-f th~'~t~I~'~ lifl~n~ " '~ ' , .. . ".." - ~ - - ~ ":~'~'; • .... .~ "~ ~ . ~ ~ ~ . ". .... =~ .., .;" " , ,P~ble~ ~ Y0fl ~V~ & =mdll ~allgPfln~y 5f the .' do whatever is neces~ry .... not'( k~ estro ens If • " ~ " = , , .-~ Solrecomme dthaty~Udo a g • ,.~ -~ .... xf the bto-s~ reveals a mah-nancv you have two " - ..... ~ • ~ . • ..... -.=.~ ~ ....... ~el that is r~Ov~ i~ rge~. Yo~ are told that.~ . -... _. f ~ .... ~ .. -, - ..... ~o~.tlusnes areacu~e, try eszrogens, .ou¢ see your~ ~¢nlla~stH ~h~&t~ [~ tt~o~eea~ =' "~ C~OlCeS, First, a~e zneone x USUally recommeno, zs ~o -" .... ~-=-* -, t~=~ ~,,~ =iv month~ ,~d ~,~ ,~-~ = ...... ~ .............. ~- ..... ,~,~,~, - re-ues" "e -"r--~n ~ot to 6"crate This allows "ou ........ , . . ~ , -~" • There ts no definite' evid~nOh..~ to ' :d~(e that ~ ~ t ,, =- ~ v • • ~ hormone aS 8OO~ aS ~881Dg~. ~" '~ "~ .... ~ .... ~' ' • . • . " ' " ' 'in v~t n ¢~nnd nntntnn In a fast~h~ln= field But it " .. ...... • ~' ....., _ : .~ ,.x- chemoth~rapx In such ~es makes any dlff~fehe~, al~ ~=a-~ • s~r-erv ~oes ahead two visits ~ the • P~ble~ ~. You smok~, tOO much. and, t~relo£e,: but'1 think Jt Is a good ~den anTWny, ]( ~ust ~ ~ew operating room insteaa el one. ou ~us.¢ wu.zc. - . ~ .- ...... . .... • , ~, ~ ~ ~ . refer to sett ............... =,,~. • • . ~.,. . , ~, .... = • ~.~ ~- ,F" ,~,. ~, ,' . Ypy :' The" bpe '. .... to c~e~ It again zn a~ut two monms. . . - "" ...... ~ - ~ .... ~.~ ,h~'bl~es~'ris~ The American: " ' ' , =~z ~" . , / ' . Not a day goes by but a doctor Is asked zf a ce~m . - . ". • ~' ',~ ~ ~ .. ,~ ~ ~ .... , .... - • 4 .... mole or wart or area of.skin is ';~uspicious." Many.j times 1 just do not know. My dermatologist friends,~ admit that they are not alw~ysstire. To be s~re,.they.~ generally biopsy the growth. I agree wholeheartedly. ] An enlarging or itching mole might be innocent, but: i It also might be a melanoma, one of tire most.: malignant of all cancers.

Why annual health checkups may rea !y e!p It's gotten to be almost as certain as death and taxes: the notification that it's again time for your annual--or, in the case of dentists, ophthalmologists, and the like, semiannual-physical checkup. Chances are that if your corporate medi- cal department is offering a free-of- charge workup, you'll do it. If it's your own doctor, who's going to charge you somewhere in three digits for the privi- lege of being poked and prodded, you may well ignore the reminder. The ques- tion is, of course, whether you're wasting your time hy going through the checkup ritual, or doing yourself a true disservice by forgoing it. There are no ready answers. The con- troversy over whether annual physicals are necessary has raged for years. More than a decade ago, Medical World News ran the results of a survey showing that, although most physicians encouraged their patients to come in for annual checkups, they admitted privately that for basically healthy people such fre- quent exams are not necessary. In the early 1970s, Kalser-Permanente Medical Center, one of the country's largest pre- paid health plans, operating on the West Coast, completed a seven-year study comparing a group of about 5,000 people who had annual physicals with a simi- lar-sized group that simply visited the doctor when they felt the need. The find- ing~ turned up no significant differences in tee health of tee two groups. Actually, there are four key questions you'll want to think about in deciding whether the annual checkup is for you • Do frequent physicals amount to overMli? Sr~ated another wa)~. If you feel reasonably well, is that a good sign that you are reasonably well? • If you do opt for frequent che~:ups, how thorough should they be? Can you get by without a sigmoidosco- py (the expensive and oft-dreaded proctologi- cal examination)? But. if you're a hea~- smok- ! or, is your doctor lax by , not insisting on fre- quent spirometry (breathing) tests? • How trustworthy are the findings of tests? For example, if you come out with a "positive" for cer~qcal -'- ::'~ cancer on a P',.p smear, '-':~' or for heart trouble on an electrocardiogram, what are the chances that you do, in fact, have a disease? • Where should you go for a physical--your personal physician, a~ specialist, a clinic spe- cializing in " ~ assembly- line" physical exams, a ~ teaching hospital, or the -~ corporate medical de- partment? 2,~ost dcctors no,,,," agree 'that annual physical3 for everyone are not necessary. In fact, tee expression "period~c heMtE examina6oa" is gaining in popularity because it implies regular checkups without insisting that they be held to yearly schedule. "Two things seem dear," notes Dr. Michael J. McGinnis, depu~- assistant ~cretary for health promotion and disease prevention at the U. S. Public Health Ser~qce in Washing- ton. "First, periodic health visits can useful. And second, annum ph.vsical~ are not an effective way to structure those visits." Many indMdual physicians and medl- cal groups recommend that people with- out ~-mptoms have no more than three physicals in their 30s, four in their 40s, five between 50 and 60, and a~.nuals thereafmr. Even the American Heart A~n. and the American Cancer Scciety PEF.SONAL EUSINESS SUF~;~LEME~4T T109782567

us can figure out the obvious Most of lhings a doctor leoks for--<Jlaucom~ ~n lhe eyes, head murmurs ~rough the slelhoscope. But s~gns of diseases show ~p in strange p~aces:For example, the eyes ~n ind~caie heart problems. Here's ~ key for some of the less obvious Hnks between exam~naffons of some bodily palls and certain dysfunctions, A Hypertension ~D B Tumors .~ C Heart disorders ABCDF D Thyroid problems ~~ CEFG E Respiratow illnesses ~~ F Liver diseases CH G Blood diseases ~ BCD H Slomach problems ~ BCF the nation's top two kill- ers. In fact, a spokesman for the AHA says that about half of all heart attacks occur in people who have exhibited no prior symptoms of car- diovascular or coronary disorders. "Often nothing x~ll show up in an ZKG, stress test, blood pressure check, and a man may be observing good dietary habits, and he still might suffer a heart attack," he admits. To some medical extorts, the converse is even more problematic: V'~hat about the healthy patient who turns up a false positive on an ~-zm a Pap srhear, or the like? "False p~sitives are not infrequent, and they c~e incredible amxietv in patients." insi~s Dr. Da,Jd Gluc.k,'J. C.~" Penney Co.'s medical director. He adds PERSONAL BUSINESS SUPPLEMENT testing, which is both expensive and in same cases dangerous. What is more, all too often even a true positive does not do much good. While a blo~d pressure teat can turn up easily curable hypertension, by the time a chest X-ray shows a lung cancer, it is probably too advanced to be cured. Not surprisingly, although most doctors continue to insist on blood pres- sure tests, blood and urine analyses, or other simple exams, Gluek and others are moving away from routine EKGS, X-rays, slgmoldoscopes, and other tests that are either expensive, uncomfort- able, or dangerous. The futility of early detection Persuading patients to act on test results can be like pulling teeth, many doctors complain. Dr. Jack R. Harnes,~" corporate medical director for American International Group Inc., did a follo~Jp study on men he had spotted as having mild diabetes. More than 70% of them did not bother trying to control their dis- ease. In fact, just one year later they denied ever having been told they had it. Although Harnes' medical department continues to offer annual physicals for employees, he notes that "the routine detection of early diabetes [may be] a waste of time, and the detection of other conditions [wdthout symptoms] not war- ranting surgery or medication also may he an exercise in futilit)'." Ironically, it is the lack of patient responsibility, that causes many doctors to come out strongly for the idea of fre- quent periodic checkups. If nothing else, it provides a ready-made followup to previous exams and ~ves the doctor a chance to work out a program of behav- ior modification for the patient who is still smoking, drinking, or eating too much. "We're in a period ~vhere preven- tion has become the name of the game, and th/s means not only early detection of disease but education of the patient," says Dr. Charles_S. Smlthen, a practic- ing internist and cardi0to~st as well as an assistant clinical professor at Cornell Medical Schcol. "If you show a .~noker that his lung capacity- was ~5% of nor- mal Ins: year and has gone to ~0% of normal this year, y~u've given him a .=o::'~a! incentive t~ -~:op smc~gng." Similarly, Dr. Isadore Rosenfeld, a cardiologist who re-d-~r~, vrote a book called The Comptcte Medical .Exam, notes that "the absolute insistence on annual physicals is probably gilding the lily, but if you demand a symptom to justify a medical expenditure, you're missing out, if not in sur~,~val, then in quality of life." Rosenfeld, like most oth- er doctors, says the interview between the patient and doctor is far more im- portant than simple test results. "Most people don't know when they're not feel- ing well," he maintains. "I've had pa- tients come in who've had thyroid trou- ble, even heart attacks, and didn't know it. When you feel lousy long enough you can forget there are other ways to feel." Of course, a feeling of well-being comes at quite a price in this country. Rosenfeld maintains that a new patient visiting an internist for a routine physi- cal, including lab work, X-rays, and should be able to get away for under $200. James H. Brennan Jr., a consul- tant at Towers, Perrin, Forster & Crosby Inc., quotes a range of $175 to $225 as typical. But checks vJth doctors around the country, show fees that go beyond $300 for a complete workup. However, a growing number of corpo- rations are picking up the tab. A recent survey by American Management Assns. showed that optional free medical exam- inations were the most prevalent perk offered top executives, with almost 65% of surveyed companies offering them. In fact, 41.5% of the ¢ompanies required periodic exams for top managers. Free physicals The practice is catching on even for nonmanagerial employees. A not-yet- published survey by the Conference "Board of 405 companies in manufactur- ing, util/ties, retailing, banldng, and in- surance showed that 41% required phys- ical examinations for production work- ers. Not surpHsingl); companies v,~th on-premises medical facilities offer ph.~ical examinations to a w~der st~ec- tram of empl~yee~. Several companies also effer free bleed pressure checks eyeD, year, even when full physicals are not part of the poE~ge. The problem vhth ~u~_h~ free BUSINESS WEE~ A,.:~st 1,q. I.~,~ 125 TI09782568

~,owever, is that patients tend either to put off spein~ a ;Irczor ~hen symptoms ~ecc, me trou~)~e~me in h~t~-een exami- havens, or alturnately, to ignore ~;mp- ~ms that ~vp up right ~vard ~e ~ey fe~ they've ~ Wen a b~]l of heMth. "I had a patient who had ~een co~Rhin~ bleed lot four months, yet d~d not come in ~cause he knew he w~ slated for a ro~tine exam," ~rou~ea one doctor. Centers that test and treat Not surprisingly, people on prepaid medical plans are more likely to visit a doctor whenever something seems awry. That's one of the pluses of the myriad health maintenance organizations (H,~Ios) or other group plans that offer year-round prepaid service. Most of them will kecp detailed records on pa- tients (an important habit because changes in physical condition are often far more important than actual physical signs themselves), are equipped to do all routine and some esoteric tests, and offer free con~aItations Mt.h a host of .¢Fecialk=ts. Many of the larger h~alth centers at t~aching ko,pitals do the same. For example, the H~spital of the University cf Pennsylvania stores patient histories in a computer and re- calls them for comparison at each visit. It is probably j~s~ a matter of time before private health-care centers, which purport not only to diagnose and treat diseases but also to handle all of a mem- ber's health-related needs, become prev- alent throughout the countD'. A good example of an existing one is Physis Inc., a IS-month-old group in San Francisco that gives the standard battery of screening tests, includes an hour-long conference w~th a physician, and pro- vides new members with a conditioning program tailored to their individual needs for weight loss, exercise, and the like. Physis provides eight hours of classroom instruction .in health care for entrants to the program and then pro- vides regular monitoring of their health throughout the year. "Physis believes the annual physical is long overdue to be replaced [hy preven6ve medicine]." in- si~t~ Dr. Jnhn J. P~:,~haw, pr,,si,tcnt and dirccter. " So far such programs remain prohibi- tively expansive for m~st t:eopIe, though. Physia" total first-year c~sts can run to $1.~00, and not surprisingly, nearly all of the ~0 people now using it have had employers pick up their costs. For most people, determining the proper cost-benefit point on annual physicals remains a problem. And the studies still go on. Just a few weeks ago a consortium of insurance companies an- nounced that it was embarking on yet another study, this one monitoring some 20,000 people over the next three years. rrhe companies hope to get data that will enable them to recommend viable pre- ventive health-care programs that do neither too much or too little. But chances are excellent that whatever they find, there will still be other health-care specialists who wilt dispute it. Cliche that it sounds, for now the frequency and extent of physical exams remain a matter between patient and physician. • f,q il~l b~i ]~ii ][Of masses in the bowets. And since the nor- What a competent docto hot oo | g ta runs down the m~ddle of the abdomen, aneuD'sms might ~ detectable. Not all physi~l exams are created equal. BuI~ng eyes may mean an overactive ~xCremitiea. Circulation t~ the legs and ~ey va~" according to thedoctor Wing th}~oid. Drooping eyelids might be a hands is checked. Early a~hritis in the them. Dr. Charles S. Smithen, a ~rdiol- sign of myesthenia ~avis, the disease hands ~n be spotted at this point. The oNst and inte~ist at New York Hospi- made famous by Aristotle 0n~sis. They nails yield a wealth of information-for ~1, offers this yersion of a "~i~" also might mean that a lung tumor is example, a skewed angle in the nail bed physicM exam, explaining what he looks pressing o~ a specific ne~e in the chest." could imply a "heart disor~r~ Reflex for at each step: An old stroke or Bell's palsy can also be tests-~ee jerks, ankle jerks, ~d the vi~al ~igna. Tempera~re: pulse, and spo~ through the eye exam. like-show whehher the brain's reflexes bloM pr~sure, wNte bo~ I}dng and Mourn, nose, and ears. TonfiiIs and teeth are wor~ng properly. smfiding and in ~th arms. If the pres- ~re are dhecked, as are s[nuses. Of R~e~al e~am. The pai~ul proctoscopy is sure ~o~.sharply in ~e s~ng ~si- course, any ~isible obstruction is checked I'.retW mu~ out of fashion nowadays. tion, it might indi~te anemia or inter- out. An extreme archness of the palate instead, the physician is likely to do a nM ble~ng. Abig d~eren~ m" pressure" mn be associated Mth a mitral prolapse, manual red~, too~ng for prostate prob- be~veen a~s might show ~ obstmc- a heart disorder. Bad breath can imply" !ems or tumom. tion in ~ ~teD' or a kink in the aorta, c~onic stoma~ problems. $c~eening iesla. Increasingly common $kin ~h~k. Pallor couId in~te anemia; Neck. An enlarged th)~oid ~ readily be st~l tesN ~e what have made the pr~- jaundi~, liver ~sease; blue ~ps could felt. A check of ~e ju~lar vein and the t~scope obsolete. Pat]en~ submit stool indim~ ~r ox5'genagon of the ~dy, ~ro~d after" c~ Nll a lot a~ut inter- s~plea from several different days, and whi~ might me~ emphy~ma or hea~ hal pr~sures in the h~--for example, the lab che~s for bl~ in the s~l. dise~e; a buttery r~h around the no~ ff ~e muscles are worNng properly, or U~ne rumples can )ield infomation on and fa~ might si~ffy a thematic con- any valves are le~ng. Feeling the diabetes, ki~ey disorders, ~d bl~ dition; ~ many bla~ ahd blue marks l~ph glands could turn up b~phatic ~rflers. Blo~ t~ ~n indi~te co~d m~ a bl~ ~sorde~ xantho- ~ncer, or even stomach ~ncer. : m~t an}~ng--~e ~ld~ level ~ght mas--~ft yellow spore around the eyea, ~he~L ~ose ~est mas~ and ~tm ~ show p~athyroid cancer, alk~ne phos- pN~, or el~wa--could ~me from high on the ba~ ~d ~eat are generally pha~se read~ ~ght indi~ Paget% ~oles~rol: ~d, of ~urse, s~n cancers che~ for fluid in ~e l~g. lmpuls~ dise~e, a ~ne disorder often mis~ag- ~uld t~ up. • . ~at come ~rough ~ a d~r's trained nosed as a~ritis. Cholus~rol probIems Nair. flit s reD- cosine ~d fMls ~ut e~i- h~ds can Mso in~ whe~er chain- show up here--in f~ one d~K ly, h~thyroi~ may ~ present. H ~ ~ ~e hem are eN~. The cheN: ~at more than 50 ~se~as ~n ~ s~t- it's ma ~e ~d s~% there ~y ~ a M~ ~e. stetho~o~ is for bron~ifis ted through bl~ s~ple~. Resting ~ec- h)Ter~b~oid coadi~on.. ~d ~y ~x~a hea~ ~unds, su~ ~ ~di~ams ~n indi~te h~n disor- ~ya~. ~e only visible a~mrie~ in the murmum. Emphysema w~ ~ show up ders, of course. Smithen recommen~ ~dy ~e ~ght kehind ~e eyes, ~d that in ~e ~est e~minago~. ~xerdse toler~ce tes~ (~Gs while a ia what d~tors ~e ~g when ~ey - AMe~. ~e dcetor "M~ f~t for the - pagen~ is on ~ ~xerdse bkTde or sNne ~e lit~e gght in. B~ atherosel~ liver, ~e spl~n, and ~e ~lbNdder-- ~) and s~irome~- t~ (breath~g rcsN and severe high blccfl pr~re mn and if he feeN ~y of thin, it pra~biy ~1 ~nly for ~fien~ over 4D who ~e s~n. The cu:er su~e of ~e eye ~n momr~ "&~; ~ ab=D~a~y enlargw~. ~ok6 or ~n~ have a h~s~D- of hea~ or show ja~dice, and, of coupe, glaucomm Kneading ~e a~domen ~ also show r~irao)w di~es ~ their family: 1~ BUSINESS W~<: ~u~ust 18. 1;59 P~SONAL EU~:b~ESS SUFP~.~ENT T109782569

WHAT SHO .=nfeld, M, explains how answers to your doctor's questions can bring you the best health care CRAM COURSE FOR YOUR MEDICAL EXAM EDrroR's NOTE: In his detailed attd invaluable book, "The Complete Medical Exam." published this month by Simon attd Schuster, lsadore Rosen[eld. M.D., le[t. tells yea things you never knew you should ask during yonr annual physical checkup. With an impressive ability to make hard health ]acts downright diverting, Dr. RosenleM casts you as your doctor's ]ull partner ht the crucial lob el maintaining your health. Using this book. with its minute-by-minute account of a comprehensive examination ~phts vast amounts el [ascinating medieal lore) as your left, you can learn what to expect, what questions to aa'k. what tests to insist on, and--thfs is vital--what inlortnatiotl you should give tile doctor to help him to keep you fit. Here, excerpted ~rom Dr. RosenIeld's book, are iust some o] the questions your examining physician will ask you, along with his reasons why. How old are ~'ou? Most patients admit their age to the doctor without any fuss. Others hesitate or give themselves the benefit of a few years, and some even insist they don't know how old they are. Whether or not 1 confide it to you, I do make a judgment as to whether you look older or younger than your age. Premature aging does not nece,~arily mean physical disease. It may be something that runs in your family or the rezult of chronic stres~personal, occupational, social, or economic--the toll of a tough, sad life, I alno allow for ~rinkling of the skin from too much exposure to the sun. On the other hand, if you are young-looking, it may be because you take gow, t care of yoursel~ and are in e~,cellent health. Or these days it may simply reflect good cosmetic surgery. What k~nd of work do .~'ou do? Your occnpation may make you vulnerable to specific diseases or symptoms. For example, miners a~d those working in a dusty environment are prone to lung dis- orders. Garage meehar~[cs and workers in ~orly tilated tunnels may inhal~ toxic fumes, damaging their heart, blood, lungs, and nervous system. Musicians, blacksmiths, typists, and those who u~ one set of mus- cles over and over again may develop pain, spasm, and cramp~, hec~u.~ of the excessive strain on the particu- lar muscle group involved. Fven teeing a d~cl~r h~ dislin~t o:cup~tionaI haz~xds, sin~ ~;e are e~!c~':.ed to the whc~le gamut of iraveetior, s. We're ~neezed, coughed, and bre~*d on. We touch and are to~ched. We get helZ~titis, even s~,~hiI~s, by aeciflentally breaking our skin ,aith a r, eedI~ ~at has dra-.;n ¢entzm~nzted h~cod. A~=_x~n:~ar ti~erman . _ .~ TI09782570

II I Your marital status Chronic anger, frustration, and suspicion, no matter where or why you experience them, can lead to ulcers, asthma, colitis, and heart attacks. The site of such stress is just as likely to be your home as where you work.. An unhappy marriage, with constant fighting and accusations or guilt of marital infidelity, can result in a train of psychoso- matic illnesses. Your family roots Specific diseases are to be found in greater numbers in certain geographic areas. For example, the Japanese have a very high in- cidence of stomach cancer, as well as the world's highest stroke rate (because of ex- cessive salt in the diet and consequent high blood pressure). Chronic bronchitis is often called "English disease" because it is so common in the cold, damp climate of Brit- ain. Thalassemia (also known as Mediter- ranean or Cooley's anemia) is a severe crippling disease of the blood that may re- snlt in early death. It occurs almost exclu- sively in people of Mediterranean origin-- Greeks. Italians, and Middle Easterners. l~.migr6s from tropical and subtropical re- gions of Africa. the Middle East, the Orient, South America, and the Caribbean may harbor schistosomiasis t snail fever }. At the time of the great influx of Puerto Ricans to the northeast United States, this disease often presented a difficult diagnostic prob- lem. Doctors didn't always think of the possibility of snail fever in midtown Man- hattan. And so, the dysentery and liver trouble caused by this infection went un- diagnosed in many cases. Have you traveled anywhere recently? Modern jet travel has made it possible for millions of tourists to visit previously inac- ce~ible areas---countries with different stan- dards of public health, and each with its own peculiar infectious diseases. Smallpox has been x, irtually eradicated from the world, but other infections h'ke cholera, ma- laria, typhoid fe~cr, and countles~ parasitic infestations cansed by worms, insects, and animals are brought back home by travelers in great numbe~. They're not always dine- East or Africa. Or if you've had diarrhea for a few days, I may think of "stomach virus," or something you ale that will clear up, maybe even colitis or tumor-- unless you tell me you've just come back from a remote part of Mexico or from Leningrad. In this latter city, the water sup- ply has been contaminated by a parasite known as Giardia lamblia, which causes diarrhea. Analyzing the stool, identifying the infecting organism, and treating with the specific antibiotic may be all that is necessary in such ¢ase~not an extensive, expensive workup. So a travel history will alert me to "'exotic" disease possibilities and avoid a lot of unnecessary worry and tests. Ill TELL ME ABOUT YOUR FAMILY It's important that you and I know what diseases affect other members of your im- mediate family, because "'the apple does not fall far from the tree." From a medical point of view, I don't really care about your in-laws except for contagious disease. I am concerned mainly with your blood rela- tives---grandparents, parents, brothers, and sisters, with an aunt or uncle or two thrown in. Are they alive? At what ages did they die and from what.'? The important diseases that run in families are stroke and high blood pressure, premature heart attacks, (Continued on page 266) DR. ROSENFELD TALKS ABOUT LIBERATION AND YOUR HEALTH By Curtis Bill Pepper The dream surprised him at first. Yet look- ing back, he realized he should have ex- pected it. It began with a young woman sitting on the edge of his examining table as he felt the sides of her jaw, then pressed his finger into a space above her left collarbone. "You know why l'm doing that?" "Yes," she replied sweetly. "Because you like me." Dr. Jsadore Rosenfeld smiled. "Don't you really want to know?" "Why?... You're the doctor." That meant she could relax because he knew it all---except that Dr. Ro*,enfeld knew he did not. Modern medicine had made great advances. It had conquered in- feclious diseases and extended life--but in other areas, it floundered. Eve~, year, near- ly one million Americans were dying of cardiovascular disease. Close to half of them popped off suddenly, like light bulbs, even though 80 percent had seen some mr shortly before their sudden deaths--to no avail. He, Dr. Rosenfeld, was a speclMist in internal medicin~ zmd cardiology, associate nosed quickly, either. Quite frankly, if ~ou have some fever professor at New York Hospital-Comell Medical Center. He worked in two clinics, and a few ach~ and pains i'mmorellkely~h df m t" t to c~l it ~u" or a "v~" ~an dzneue ~ - - " .... fever or tsutsugam~ dts~i~, ~I1 ~tten fifty scientific pa~, w~ ~ll~a- of cou~, you tell me you'~e jr~t come eZCK fro~ a ~:~on in t~ Ca6b~, ~= Far the American College of Physicians, Ameri- can College of Cardiology, Royal College of Physicians of Canada, consultant to the Na- tional Institutes of Health and to various government task forces to fight arterio- sclerosis, hypertension, sudden death . . . and so on. Yet he didn't know it all and he sought to explain it to the young woman wearing an examining gown as she sat before him. "Listen, you know your body in a way better than any doctor can. Certain symp- toms have a built-in quality that tell you whether they're important or not. You have to know what they are. Because if you walk out of here today with a dean bill of health, you might need to know how these symp- toms can speak to you sometime later. It will help me . . • and one day may save your life." She hesitated. "All right," she said softly. "Tell me what you're doing to me." Dr. Rosenfeld explained he'd been feeling for her lymph gland. If enlarged, the gland could indicate leukemia, cancer, or an in- fection. Since it had that potential, it was often called the "sentinel" gland. "So ho;,;'s my sentinel?" "Lo';ely... I can't feel it." She laughed, relieved--and curious. As tie doctor continued to thump her ch~t, (C~ntb, ued on page 2651 I 243 I I TI09782571

YOUR HEALTH ~C*~:ztimted [r,~w~ Fa.;e 243t l~U~h in her belb, and hammer ker cl~cckup. ~-~s brought into his e~ No matter how rushed. ~he doclt~r allo~ed no patient Io feaze with unanswered qu~tior~. The young woman queried him further, lhen confessed. "'i£s been fun. ! feel like your a~iManl." -Ym~ are. ~he best one po~ible." It wasn'l lhe firm time Dr. Rosenfeld had changed a p~dient from a passive spectator U) an active participant during a checkup. it was. howe~er, a decisive moment. He told iris wife. Camilla. abtmt il when he cam~ "I've dec~ded [o write a book." "'Wonderful. Wha~ abourY' "How io gel the most out of u checkup. What to expect from ~ go~ one, and ho~ medical ~arc depends not only on (he d~- lot hut on what he shares with the patient. "Call it a dream. Call it crazy or ~hal you wahl But it might improve medical care and help millions of people." Today, one year later, Dr. R~enfeld's dream is u reality. His b~k, to be pub- Itched Ihls monlh by Simon and Schuster. called The Oomph,to t~l£'dicttl ~am. with subtitle: ~Vhal Yollr Doctor Knows Is Criti- cal: What You K/to~r Is Crltcial. "[ think it's a doll litle," says Dr. Rosen- reid, who wanted to call the book jnsl Ch('c~ tip] The d~or was seated ~efore the fire- place in the living room of his Manhattan apartment where he had walked an esti- maled 520 miles while dictating inlo a re- corder and pacing back and forth in a year of weekends. At fifty-one, lsadore Rosen- reid has the face and manner of an old-time family doctor. One notes gentle brown eyes behind horn-rimmed gla~, lhen a furrowed brow as he ponders and pulls on a ~rpetually nnlit pipe. The doctor's wife, Camilla. was in the kitchen baking bread--s hobby no one in lhe family would ever discourage. Two sons ~Arthur, twentymne, and Stephen. nine- leen~were at Yale. The one daugMer, di. sevenleen, was at Ihe Dalton School And Herbert, thirteen, was in his room wilh a buddy and two ~et snakes. Dr. Rosenfeld ~egan by noting that lhe doctor's role wilh women pali~ms has changed with their altered role in s~iety. "A woman's role is no longer limiled Io ~he household, whether ~he's on a farm or in the city. Formerly, a d~lor saw a woman s~eifieally for menstrual disorders, or Ior pregnancy, or for household "There's been an amalgam, a fusion tween the sexes, minimizing lhe difference Ihal used Io exisl~in the d~lor's eyes. any- way--between lhe male and female A patient is a patienL Unless you are a gyn~ologisL you don't think of them differ- enlly. You [hink of ihem as ~ople. rather lhan as members era At Ihe sam~ time, ~x dM make a differ- ence in vulnerability Io cerlain diseases. ~ea~ing also on age. ~]t's still tru~ that heart attacks are rela- tively uncommon in women ~efore p:~use, excerl for those who have h~h ries removed), or blalant abnormalities of their bl~o~fats or ehoI~sterol~x~h]ch can Women £.ccd et~.er prob,~em,. Upon i:~h~ded smo~,i~g, drinking, a~czh~ed cf- leers of the Pill, psychic stress, hyperlen- ":~ctte ~o~n~ ~ecaIJy among ~oung women, renders lhem more vulner- able to hazard~, including cancer. When 1 was a medical studenL twenty-eight years ago, hmg cancer seemed less common ~omen. I think irs ~cause they ~ere smok- ing less then. Curiously, despite warnings in the press and even on the package itself about smoking hazards, lhere is a marked reduction in cigarelte usage by men, yet a significant increase among young women. This also applies to alcohol consumption," Yet. modern woman v, as Ihreatened with more than tobacco and alcohol. Upon emerging from her home, she entered a new and hostile world of curcinogens~ancer- ceasing agenlx. "~Ve don'l know all the carcinogens in oar environment. Every day, something else is implicated. The air we breathe, the fo~ we eat, the clothes we wear, the pills ~e lake, what we apply to our bodies~even some hair dyes. When lhe woman remained a{ home. she was less vulnerable to much of this, especially commercially prepared foods. Now, she's subject to the same en- vironmental influences as men." The Pill also broadened the spectrum of women's vulnerability to disease. "'When we give a young woman a contra- ceptive pill, we not only have to think of its efficacy in preventing conception, we also have to consider her vulnerability to vascular disease, hypertension, stroke, even nmlignancy~and venereal dimase. "'The traditional reservoir of venereal dis- ease used to ~ the prostitute~but, no more. Not in this age of sexuM freedom." Sex ilself was another problem. Women had always wanted it~but often kept theh" feelings to lhemselves. Today, they pressed their wishes more openly, were more critical. Dr. Rosenfeld observed this sexual frankness in wives oI male patients. "'They insist on aceompanylng their hus- bands into the consnlting room. They take part in discussions about prognosis and management vahmtion of the disability, Then. lhey ask about possible influences of certain medicines on male potency. The man is often shy. Bat the woman will ~y, "Will this drug cut down on his sexual per- formance?' " This put a greater stress on the man. Sexual relations were no longer a male game. done at his convenience, • "Previously, if a man was inadequate~ if il didn't work ear--his relalionship with his wife. his partner, was not fundamentally threatened. Today, a woman who is not satisfied says so, Or maybe g~s on gr~ner p~Itlres. This constant assessment is a slrain on a man. rm nol a sexologist. but the growing f~ns on the orgasm or the mutual orgasm has, I believe, interfered with natural ~x. ~'re losing something in the process." At the same time. in the ~eld of medical ea~. there ~a~e been immense leading toward belter health, longer lives. "I don't think irs properly ~ppreeiated drop in t~e death rate due t~ hi~ pressure and 35-percent reduction in send you the ffany Sterling Booklet, free? Tiffany sterling collection o] gifts for weddings, anniversaries, births and graduations... when silver is so appropriate. City. State Zi~ TIFFANY&CO. NEW YORK FIFTH AVENUE & 51TH STREET. ZIP 10~22 Teraperclla is known to be SOFT enough for Highlighting. FiRM enough tot lining and SMOOTH enough for color. 23 Glamorous Shades ranging from black to the decpc.~t red. 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_.. r~EALTH ~t~m/~er of *-trokes. Th,'re's b,'en ~n C~nt drop ira ~eart att::ck,~ in the Ias~ years alone. And. for the first tim=. the hamster of deaths from cardiova~cuIar dis- ease has fallen to below the million mark. "So, lhere's been a substantial redaction in the death rate which more t~ople should know about and appreciate." Slill. we were only at the threshold. More disco,,efies lay ahead, especially in a greater under.~t~nding of the internal chemistry of lhe haman body. It could le;td to a new world in the control of di~ase and the pro- longation of life. Dr. Rosenfeld believed a key to this lay in greater knowledge of the body's hor- I I~1 MEDICAL EXAM (Continued Jrom page 243) diabetes mellitus and blood fat disorders. cancer, mental disorders, and allergy. In addition to inherited traits, you may share certain disorders with olhers in your family by virtue of common exposure to social and environmental factors like hous- ing conditions, chronic infections, hygiene. eating, drinking, and smoking habits. Have there been many heart attacks in your family? The commonest cause of death in most Western countries is the heart attack, kill- ing more than 600,000 people each year in the United States alone. If your parents died from this disease before they were 65, or if any of your brothers and sisters had a cow- x :~rialh~s in ~rmo~e l~els ~a~ ~: re~on- c~ that ~z cannot now explain. Ye~ it i5 ~ot likely Io ~e simply IE~ i~Iated hor- mone in itself, b~t rather h~;. it inte~ lares ~ith other hormone. "Women. prior to menopause, do not have as many heart attack~ as men. That would lead you to ~y ifs a matter of hor- mones. With this in mind. several investi- gators gave men eslro~en~the major female hormone--only to discover they had created a reverse pro~ess. Men ~ho received the hormones developed bl~ clotting with other side effect. ~, the substitution of that hormone d~sn't provide the answer. It indicates, however, lhat the difference be- Illl nary attack. I will want to know about it to try to protect you from the same fate. i may not always ~ able to do so, but it's worth a vigorous effort. There's no magic pill or guaranteed regimen. We simply have to work together trying to reduce or eliminate all the known risk factors that may increase your vulnerability. I will urge you to give up Lmoking, keep your weight and blood pressure down, eat a "prudent" diet low in cholesterol, and exercise regularly. Are you cancer prone~ Cancer of the lung, stomach, prostate, breast, cervix, or bowel may occur with frightening frequency in a given fa~ly. This may be due to genetic factors, trans- mission of some viruses we haven't yet iden- tified, or even common exposure to harmful environmental factors. We iust don't know. t~een ~en a~:l ,;om.an--~i:h r~':~ to ~-~tn:rabilhy to this ma:,or dk~,: cf W~- em m~is still not urd:~tca5 an~ ~rcb- abb' ~as to do "~ith h~onal differently Dr. R~senf~I~ falt cenfi~:nt that the ~ers "aould ba feund. "I think the d~ag- ~t~is of neuros~s, anxiety, funclinnal turbance that en~s up with no physical basis is going to go down ~ our k~owledge of how the body functions goes up. "We're still in t~e infancy of medicine. When v;e finally know what makes t~e tick, life ~v~l ~e prolonged. Not that life in it,ll is so desirable if it's accompanied by physical infirmily and de~ilily. Btll I think that as we understand more, people ~ill reach extreme old age, and a man or wom- ~n of ninety in the future will act lhe way a ~rson of forly d~s t~ay.'" ~ So. if when we discuss the health of other members of your family, you can tell me that several of your blood relatives had cancer, I will be espeeially careful to exam- ine you for early evidence of the disease. Are any of your relatives diabetic? Diabetes is a disorder of sugar metabolism. It runs in families, so if any of your blo~l relatives are affected, you should be regu- larly tested throughout life with urinalysis and blood tests. When the disease begins in adult life, it is called chemical or maturity- onset diabetes. It does not usually cause the severe disease of arteries seen in children, in whom the eyes, brain, legs, kidneys, and heart are so often affected. Do you come from an allergic family? Asthma and hay fever, as well as sensitivity to certain foods and drugs, often run in TI09782573