The Federal Government and Medical Libraries, 1964
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The Federal Government and Medical Libraries* by Martin M. Cummings, M.D.** Mrs. Kuehn, Miss Annan, Dr. Craig, guests, ladies and gentlemen: This is my first opportunity to address any element of the Medical Library Association. I regret that I am not a professional librarian, but I am proud to be considered a friend of libraries -- I must be -- since I am married to a librarian. She is a weeder -- she gives away my books and I must go out and buy them back. I am sincere when I say it is an honor to be here. The medical profession has a genuine debt to this Association. You are endeavoring to maintain high standards in medical librarianship and you are seeking diligently to help librarians work more effectively with physicians and medical scientists who need your services. Thus you are concerned with the maintenance and improvement of the health of the American people. As a physician I can say I know of no higher calling. I think that sometimes we may lose sight of the real objectives and purposes of medical documentation and information. Particularly those of us involved deeply in the administrative aspects of medicine -- we sometimes can forget that the ultimate purpose of our work, is the improvement of man's health. When 20th century American history development is finally written, I believe that our concern for the individual and his health will be one of the significant highlights of this era. Never before in any age has any nation or government or people been so concerned with the health of its population. Never has so much money been spent for a peaceful purpose. [*Presented before the New York Regional Group of the Medical Library Association, New York Academy of Medicine, President's Gallery, April 22, 1964 **Director, National Library of Medicine, Bethesda, Maryland]

Page  2 Never have there been so many government and private organizations concerned with man's illnesses. Never have there been so many people engaged on a fulltime basis in the task of helping people recover from their injuries and ailments and seeking to keep them healthy. You will be interested, I think, that the National Institutes of Health estimates the number of fulltime, professional American personnel working in the health field to be more than 3 million. This affects us because these are potential medical library users. Impact of Federal Programs It is my conviction the fiederal expenditures for support of medical research and training has placed an overwhelming burden on medical libraries and thus a major responsibility now rests with the Federal government to solve the problem it created. Let us consider the size of the problem with which we are dealing. In 1940 the U. S. government spent $3 million for medical research. Today the Federal agencies are spending about $1.1 billion in the health-related sciences, more than 333 times as much as in 1940. With respect to training, the number of biomedical scientists has more than doubled from 19,000 ten years ago to 40,000 today. Medical scientists will double again by 1970 -- because it is part of our national plan and need. This Federal emphasis on research and human health is well placed. It is one of the things which makes this a great nation. But it has contributed significantly to the problems of medical communications. Not all of these problems are directly attributable to the Federal support of medical research; but the Federal government is spending, and has been spending, vastly more than any other element of our society -- $5 billion during the past 10 years. It is thus obvious that these expenditures indirectly have contributed very

Page  3 heavily to the tremendous growth of the biomedical literature and to the demands for more and different types of literature. Whatever the degree of Federal responsibility for the problem, we have a curious discrepancy in our legal authorities to do something about it. In respect to the physical sciences, several Federal agencies, such as the National Science Foundation, have ample authority to support mechanisms for improving communications. In the medical sciences these authorities are rather limited. This is not deliberate discrimination. It is one of those sad oversights of democratic government. However, it may be due also to the fact that both the private and public elements of the biomedical library community have not adequately placed their needs before the public or Congress. I think we can and should accept the fact that those of us most intimately concerned with medical communications have not done our job adequately. With all of the emphasis on medical research and medical care, we have permitted the critical vehicle of communications -- the library -- to be neglected. Magnitude of Problem Let us consider for a moment the sheer size of the problem. It is not new to you. Less than half of our nations medical libraries meet minimum standards. We have a new kind of example which is a little staggering. It was developed by Dr. Arnold Lazarow, Professor and Head of the Department of Anatomy of the University of Minnesota Medical School. Several weeks ago Dr. Lazarow was testifying in behalf of medical libraries before the House Subcommittee on Appropriations concerned with Labor and Health. This is what he said: "On a world-wide basis, in all countries, languages and disciplines, there are almost 1,000 biomedical scientific articles being published

Page  4 every day of the year. Each one of these articles averages about 15 pages. That's a total of 15,000 pages a day or 4,500,000 pages a year. If they could be piled on top of each other, the stack would be three times as high as the Washington Monument or taller, even, than the Empire State Building. These figures do not include additional medical materials, such as textbooks and handbooks, monographs and other volumes." No one has to tell you about the impact that this situation has had on the medical libraries, whose difficulties constitute the core of the entire biomedical communications problem. Inadequacies in space, personnel, training, collections, equipment and funds are not new to you; and the fact that the libraries need outside help is not new. I have been interested to learn that the matter was referred to at the first meeting of your organization, when it was the Association of Medical Librarians, in Philadelphia, in 1898. Dr. George M. Gould, the Philadelphia opthalmologist, read a paper before that organizational meeting, referring to the matter of "securing endowments for libraries." The difference today is in magnitude and in the effects the libraries' problems are having on the whole of medicine. Dr. Edward Dempsey, Dean of the School of Medicine at Washington University in St. Louis, has referred to the situation of the medical libraries as "tragic" and "disastrous." Dr. Michael DeBakey, Chairman of the Department of Surgery in the College of Medicine in Baylor University, has called the library situation "chaotic." Both of these men have suggested that the reading of many doctors and scientists today seems to be inadequate because of their inability to gain access to the literature they need in their work. These men and many others

Page  5 are now prepared to work for Federal support for medical libraries, as in the past they have worked for Federal support for research and education. programs; and more importantly through the development of extramural programs, NLM Activities The National Library of Medicine has become aware of the situation in recent years. The Library is conscious of the need for action in two areas: within the National Library of Medicine itself; in its traditional service through which the Library can give funds to meet the needs of the medical libraries across the nation. For those who say libraries are no longer needed, I can only cite the tremendous demands made on our own institution. Here are some examples of these increases: In Fiscal Year 1963, the number of readers registered went up 86 percent over Fiscal Year 1962, to a total of 21,484. The number of reader requests filled increased 49 percent, to a level of 70,791. The number of reference requests went up 30 percent, to 13,378. And the interlibrary loans increased 19 percent, to 134,918. This doesn't sound like a lack of interest in using library resources. MEDLARS began its operation this year. Most of you, I am sure, are already familiar with the purposes that MEDLARS is serving in producing Index Medicus. With further effort it will also be able to produce up to 150 recurring bibliographies from specialized fields and handle more than 37,000 demand searches every year. The impact of this development will be felt in all activities concerned with the printed word. However, MEDLARS is a library instrument, it is not a substitute for a library. In another program concerned with getting information out of NLM to the people who need it, our photoduplication activities have continued to

Page  6 increase. From 1962 to 1963 there was an increase of 20 percent, to a level of 128,399 orders -- a total of almost 2.5 million pages. In our efforts to establish extramural programs, we have been encouraged by the support we are receiving from the Office of the Surgeon General of the Public Health Service. Much preliminary work has been necessary before the new legislative authorities could be obtained; and we have assurances that these new programs are being supported by the entire Public Health Service. The support of the Board of Regents and the National Advisory Health Council is assured also. The National Library of Medicine is no longer alone in its pursuit of these new authorities. We also have been encouraged by what we consider to be a measure of success in clearly defining the specific areas in which we feel Federal support, through NLM, is mandatory. I would like to outline them to you since nearly all of them concern the nation's medical libraries. Construction We believe that the medical libraries, particularly those in educational settings, must be assisted with new construction. The problem of space is desperate in many libraries, and it is growing worse. We are seeking authorities for matching grants to help meet this need. Training We believe there are needs for training of several types, in medical librarianship itself at the masters and doctorate levels and in programs of retarianship itself at the masters and doctorate levels and in programs of retraining medical librararianship itself at the masters and doctorate levels and in programs of retraining medical librarians. We believe the institutions which offer training in librarianship should be strengthened; and we believe there should be developed programs for training communication specialists, in information processing and technology.

Page  7 Fellowships We want to be able to offer special fellowships to physicians and scientists for the compilation and/or writing of original contributions to the literature. Research The research field in librarianship and the whole of communications is tremendous in scope. It offers the key to many other aspects of information handling. Research, as I am sure you agree, is needed in the processes of the libraries themselves; in new communication techniques; in computer technology and the uses of mechanization, and in man-machine relationships. Resources It has long been apparent that something must be done to help the libraries improve their resources, in books, journals, equipment and in overcoming cataloging backlogs. One aspect of our planning would seek to help the medical libraries with a subsidy to help them meet minimal library standards. Regional Libraries The gorwth and specialization of the literature, and the needs for faster access, have made it necessary that we establish a national network of regional libraries. These would be resource centers to help meet the needs of other medical libraries in their geographic areas. These must be developed around existing centers of excellence and be supported on a sustained basis. I believe it is safe to say that at this point in history the Federal government is now awake to the needs in biomedical communications and to its responsibilities in this regard. At NIM at least, we are encouraging a

Page  8 broad and energetic Federal effort to help speed and improve the flow of biomedical information. Our central concern is the medical libraries. In recent years the medical libraries have been severely criticized for their weaknesses. They often have been condemned for their seeming inability to lift themselves to the levels required by modern teaching, research and service. Some of these charges may have been unjustified, but whether they were or not, the question that must be asked at this point is this: Are the nation's medical libraries prepared for the requirements of the future in terms of concepts and planning? The medical libraries face challenges which are without precedent in their history. I continue to hear some librarians say that the basic principles of librarianship will not change. My response to this is that you must define "principles," and you must be prepared to defend the case for their invulnerability and durability. Otherwise you must be prepared to accept change. I have heard it seriously stated, by men deeply concerned over the interchange of scientific information, that the library as we have known it for many centuries has outlived its usefulness. They talk of the disappearance of the book and of the substitution of films and magnetic tapes. They talk of the library being replaced by electronic data processing systems, which, among other things, could flash graphic images of whole articles around the world in a few minutes. This is not irresponsible talk. There are sound reasons to believe that such things, from a technological development standpoint, may be possible in the near future.

Page  9 I think you will agree that it would be most unwise for the medical libraries to try to fight a blind, defensive battle against the possibility of some such changes in the future. I think you will agree that your task is one of meeting the challenge head-on. You must help fashion the new developments to achieve maximum efficiency and effectiveness in relation to existing and more tested library processes and procedures. Your ideas, your creative planning, initiative, and energy will be prerequisites to the initiation of an effective program of Federal support. I would draw no limitations on your development of new and imaginative appraoches to the library's role in the interchange of biomedical information. On the contrary, I would encourage you to plan thoughtfully and carefully and freely on the six areas I outlined earlier: construction, training, fellowships, research, resources and development of regional libraries. I would invite you to think beyond these areas, to concepts which we have not thought of. To a great extent, the initiative for planning for the future, as well as the major responsibility for making these grant programs work properly, will be yours as well as ours. Clemenceau, the Frenchman, said that war was too important to be left to soldiers. I do not believe that librarianship is too important to be left to librarians. I believe that the American medical library community abounds in all of the basic skills necessary to overcome the challenges of the present and the future. I do know that these skills must be brought to the fore, with alacrity, and exploited to the fullest. The critical nature of the information and library problem and the needs of the mission which we serve in medicine will not permit otherwise. I am prepared to work vigorously for Federal support of medical libraries -- but I will need your help and advise. There are insistent demands for answers and action. We must provide both. Thank you.