In many places, getting a new job - especially a senior position - depends on passing an expensive medical examination. But now a Tel Aviv University researcher suggests that such a checkup could better be done by a paper-and-pencil quiz. For the disabled, people with serious or infectious diseases or those who are just stressed at the thought of a doctor's waiting room, undergoing a medical exam to qualify for a job can be daunting. These examinations are vital in the US, as employers there pay for their workers' health insurance, unlike in Israel, where there is a national health insurance system. However, Israeli employers have been using the questionnaire since 2000. It includes several dozen questions, including: Are you taking medications regularly? Have you ever filed a disability claim? Do you have allergies to any food and medications? Have you ever been injured in an accident? Dr. Shlomo Moshe, an occupational physician from TAU's Sackler Faculty of Medicine who also works for Maccabi Health Services, argues that medical exams are often not an accurate predictor of competency or job performance. He maintains that physical and psychological tests can be replaced by filling out a questionnaire, and that this can gauge the candidates' physical and mental health much more accurately. "A questionnaire can effectively rule out those who are not fit for white-collar and non-hazardous blue-collar positions," Moshe says, "and with our test, more people are actually found fit for work than when they are assessed by a medical exam." The potential savings in medical costs are enormous - as are the costs of lawsuits after a rescinded offer. Currently, the Americans with Disabilities Act passed by Congress means employers can't order medical tests for prospective hires until after a job offer has been made. Since the act went into effect, a number of complicated lawsuits have arisen from companies cancelling job offers. "It's only natural that an employer wants to be sure he won't be affected by an employee's medical problems, and that a disability won't affect job performance," says Moshe. "He wants a certificate of health. Now we can give that without extracting a drop of blood or urine." Based on data collected during his experience as an occupational physician and from insurance companies, Moshe's non-invasive "medical test" can be performed in an office or online. Results indicate that the predictive power of the test is so strong that it can not only eliminate unnecessary medical exams, but also help those previously deemed unemployable find suitable work. The TAU team who conducted the study found that 98% of all people who take the questionnaire are correctly deemed suitable for employment. The test is so effective that occupational experts in America have been asking for a copy of the questionnaire. It is now available in the Occupational Medicine journal that reported on Moshe's study. Most of the medical tests currently used to screen prospective employees were developed decades ago, when workers were frequently exposed to dangerous substances such as lead and asbestos. Because new safety standards limit the incidence of exposure to such toxins, a majority of traditional medical tests are completely redundant, Moshe insists, and major communicable diseases like tuberculosis, formerly common, are quite rare in the Western world today. "Obviously, employers are afraid of lawsuits and poor performance on the job," Moshe concludes. "Our test gives everyone in the system job security." PLEASE SIR, I WANT SOME MORE In Charles Dickens's famous novel Oliver Twist, Oliver in the 1830s workhouse complained about being hungry. But now dietary experts suggest in the Christmas issue of the British Medical Journal (BMJ) suggest that the poor boy's diet - while dull - wasn't really so bad. The BMJ's Christmas issue is chocked with ironic, odd and amusing research studies, but all of it was conducted scientifically. UK researcher Sue Thornton and colleagues compared menus and other historical material on workhouse diets with Dickens' fictional description of what Oliver ate: "three meals of thin gruel a day, with an onion twice a week and half a roll on Sunday." And on feast days, the inmates received an extra bit of bread. Dickens' invented diet, say the authors, would have been completely inadequate for health and growth. They used a computer program to compare the nutritional content and population requirements in Dickens' diet to Dr. Jonathan Pereira's "workhouse dietaries." Interestingly, the authors note that historians have suggested that modern dieticians might approve of workhouse diets because of the coarse, less refined workhouse bread. Unlike Dickens' description of gruel, the recipe analyzed by the authors is substantial, as it contained some of the best Berwick Oatmeal. The Pereira diet would sustain growth in a nine-year-old child unless heavy physical activity took place every day. Other historical data also show that large quantities of meat (beef and mutton) were delivered to London workhouses. The authors conclude that assuming the workhouse children received the amount of food they were due, then "the diet was not as bad or harmful as that related by Dickens." They point out that while the new Poor Laws obviously made Dickens very angry and perhaps brought back childhood memories of his own hardships and deprivation, historical evidence does not back up some of the claims he makes in his novel.