From its inception, multiphasic screening captured the imagination of the medical profession. Glowing articles depicted the vast amounts of unsuspected disease that could be diagnosed early, often in preclinical stages, with dramatic declines in the need for hospitalization and tremendous cost savings. Unfortunately, the early enthusiasm was clearly overstated. Multiphasic screening turned out to be a mixed blessing.
Elsewhere in this issue,1 Donald M. Berwick discusses screening in health fairs, a most appropriate topic at a time of focus on the burgeoning costs of medical care. Berwick states that in 1984, "health fairs across the nation performed 1.5 million measurements of height and weight, 300,000 tests for glaucoma, 200,000 hearing screens, and nearly 20 million blood chemistry tests." Health fairs thus have substantial potential to aid (or hurt) patients and to support (or diminish) physicians' efforts and thereby impact medical costs.
In a large sample of participants in health