1965 U.S. Senate Appropriations Committee Budget Testimony, 88th Congress 2nd Session, May 22, 1964
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LABOR—HEALTH, EDUCATION, AND WELFARE APPROPRIATIONS FOR 1965 HEARINGS before the SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE EIGHTY-EIGHTH CONGRESS SECOND SESSION ON H.R. 10809 MAKING APPROPRIATIONS FOR THE DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES, FOR THE FISCAL YEAR ENDING JUNE 30, 1965, AND FOR OTHER PURPOSES PART 2 (PAGES 1053 TO END) (FRIDAY, MAY 22, 1964, THROUGH WEDNESDAY, JULY 1, 1964) Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 3o-y-)2 WASHINGTON : 19640067051_000002.txt

Page  2 DEPARTMENTS OF LABOR, AND HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES APPRO- PRIATIONS FOR 1965 FRIDAY, MAY 22, 1964 U.S. Senate, Subcommittee of the Committee on Appropriations, Washington D.G. The subcommittee met at 10 a.m., pursuant to recess, in room 1223, New Senate Office Building, Hon. Lister Hill (chairman of the sub- committee) presiding. Present: Senators Hill and Byrd. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAPvE Public Health Service National Library of Medicine STATEMENTS OF DR. MARTIN M. CUMMINGS, DIRECTOR, NATIONAL LIBRARY OF MEDICINE; ACCOMPANIED BY SCOTT ADAMS, DEPUTY DIRECTOR; RAY W. GRIM, EXECUTIVE OFFICER; DR. DAVID E. PRICE, ACTING SURGEON GENERAL; AND JAMES F. KELLY, DEPARTMENT BUDGET OFFICER Appropriation Estimate "National Library of Medicine "To carry out section 301 of the Act with respect to translation of foreign scientific documents and for expenses, not otherwise provided for, necessary to carry out the National Library of Medicine Act (42 U.S.C. 275), [$4,074,000] $5,683,000." Amounts available for obligation 1964 1965 $4,074,000 10,000 $3,633,000 Comparative transfer from General". _____......___ "Salaries and expenses, Office of the Surgeon Total_______________ 4,084,000 3,633,000 10530067051_000003.txt

Page  3 1054 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Obligations oy activity 1964 estimate 1966 estimate Increase (+) or decrease (-) Posi-tions Amount Posi-tions Amount Posi-tions Amount 263 $3,504,000 276 $2,803,000 260,000 580,000 +13 -$701,000 +260,000 Publications support..________________ 6 680,000 5 268 4,084,000 281 3,633,000 +13 -461,000 Obligations by object 1964 estimate 1965 estimate Increase (+) or decrease (-) Total number of permanent positions____ Full-time equivalent of all other positions. Average number of all employees________ Number of employees at end of year: Permanent positions________________ Other................................. PUBLIC HEALTH SERVICE Personnel compensation: Permanent positions___________ Positions other than permanent. Other personnel compensation... Total personnel compensation......_______________ Personnel benefits................______..........._____ Travel and transportation of persons.....____......______ Transportation of things.............__________.......... Kent, communications and utilities...............;_______ Printing and reproduction_____________________________ Other services________________________________________ Reimbursement to "National Institutes of Health management fund"________________________•______ Supplies and materials.....___________________ . Equipment___................................ Total, Public Health Service. ALLOCATION TO LIBRARV OF CONGRESS 11 Personnel compensation: Other personnel compensation 24 Printing and reproduction____________________________" Total, Library of Congress. Total obligations by object. 268 1 251 260 $1,620,000 6,000 24,000 1,660,000 126,100 26,300 2,700 140,600 152,000 699,900 345,000 82,000 952,400 4,076,000 4,000 4,000 8,000 4,084,000 281 1 264 273 $1,729,300 6,000 17,700 1,763,000 134,400 25,300 2,700 115,300 168,900 864,900 350,000 88,000 132,600 3,625,000 4,000 4,000 8,000 3,633,000 +13 +18 +13 +$109,800 +103,000 +8,300 -25,300 +16,900 +255,000 +5,000 +6,000 -819,800 -451,000 -461,0000067051_000004.txt

Page  4 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1055 Summary of changes 1904 enacted appropriation____________________________________$4, 074, 000 Comparative transfers__________________________________________ 10, 000 Total estimated obligations, 1964__________________________ 4, 084, 000 1965 estimated obligations_____________________________________ 3, 633,000 Total change___________________________________________ —451,000 Increases: "Built in": 1. Annualization of phase II and commissioned officer pay increases_________________________________________ 37, 700 2. Annualization of medlars program, including 25 new posi- tions authorized for 80 percent of 1964_____________ 29, 000 3. Increase in cost of utilities and building maintenance services___________________________________________ 5,000 Subtotal, "built-in" increases_______________________ 71, 700 Program increases: Expansion of bibliographic services through medlars____ 85, 200 Establishment of decentralized medlars search center______ 250, 000 Increases in public services and in preservation of the collection____________________________________________ 35,100 Subtotal, program increases__________________________ 370,300 Gross increases______________________________________ 442,000 Decreases: Nonrecurring equipment costs (medlars)____________________ —886,000 1 less day's pay in 1965____________________________________ —7,000 Subtotal, decreases_______________________________________ —893, 000 Total net change requested_______________________________ —451, 000 explanation of changes Expansion of bibliographic services through medlars An increaes of $85,200 and nine positions will enable the Library to analyze and process, through its computer-based medlars system, an additional 20,000 medical journal articles each year. It also provides for procurement of addi- tional equipment which will increase the speed and efficiency of literature analysis. Establishment of decentralized medlars search center The $250,000 requested will be used to establish and support a university search center to test the effectiveness of decentralized use of the bibliographic information compiled on magnetic tape by medlars at the National Library of Medicine. This will make it possible to utilize NLM's generated tapes on other computer equipment. Increases in public services and in preservation of the collection An increase of four positions and $35,100 is requested to meet additional work- load in the inter-Library loan program and to permit increased efforts to preserve deteriorating materials in the collection.0067051_000005.txt

Page  5 1056 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS New positions requested, fiscal year 1965 Grade. Annual . salary QS-ll $,424 OS-11 8,424 Q8-9 7,080 QS-9 14,000 OS-9 7,080 QS-5 4,701 GS-4 8,444 QS-4 4,223 OS-3 7,780 OS-3_„. 3,890 Library services and resources: Senior Indezer............. Programer................. Librarian.................. Indejer (2)............___ Searcher.................... Proofreader................ Typist (2)................. Clerk..........____........ Library assistant (2)....... ' Office machine operator___ Total new positions (13), National Library of Medicine. 74,008 Significance of Work Performed by Library Senator Hill. The subcommittee will kindly come to order. Doctor, we are happy to have you here with us. You may proceed now and make any st atementyou see fit, sir. Dr. Cummings. Thank you, Mr. Chairman. Since this is my first appearance before this subcommittee as Director of the National Li- brary of Medicine, I should like to preface my remarks by sharing with you some of my personal convictions as a physician, as scientist-admin- istrator, and now as Librarian, of the significance of the work which NLM is performing. Senator Hill. We will be glad to have you do that, Doctor. Dr. Cummings. I should not have accepted this responsibility were I not convinced that the American society is in process of reevaluating those institutions which organize new scientific knowledge, and put it to work to the society's benefit. The American people are spending large sums supporting medical research for the purpose of generating new knowledge. It is my belief that this knowledge has but nominal values until it can be successfully communicated to other researchers, to students and practitioners of the area of medicine. Senator Hill. May I interrupt to say I could not agree with you more strongly than I do on that statement ? Collection of Specialized Information Dr. Cummixgs. Thank you, sir. The National Library of Medicine holds the world s largest collection of specialized information in the held of medicine, public health, and biomedical research. All of the major and minor languages are represented in its holdings, and ma- terials flow into the Library through a worldwide collecting network of bookdealers, publishers, exchange partners, and foreign govern- mental and nongovernmental institutions contribute to our holdings. I his makes our institution an international resource containing the world s comprehensive scientific record in the field of medicine The total scientific literature is expanding at an unprecedented rate0067051_000006.txt

Page  6 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1057 Publications Explosion The increasing growth in quantity, the very bulk of the literature in all of the sciences, has brought about what has been known as the publications explosion. This has severe implications for our society. Unfortunately, however, library facilities and resources for man- agement of the literature have not kept pace with these increases. The challenges and problems associated with these developments are manifold and complex. All fields of science and technology are in the process of reviewing their mechanisms for handling this expanded literature. The gap between the generation of new knowledge and its applica- tion must be narrowed if society is to reap the benefits of its invest- ment in research. There has been accordingly, a revolution in think- ing about the processes of scientific communication, a revolution in which the Library has shared. Techniques for Scientific Communication Some of the existing techniques for scientific communication (meet- ings, conferences, publications, and library services) have survived the tests of time. But it is evident that they do not go far enough. We must find new ways of producing, managing, and transmitting scien- tific information. Research developments—many undreamed of just 5 or 10 years ago—in mechanizing information handling, in electronic computers and high-speed printing techniques are just emerging. Medlars Project The NLM, with its medlars project, has already assumed national leadership in the medical communications area. However, it must continue to exploit its present capabilities while seizing every oppor- tunity to improve and speed further technical developments. Partic- ularly must we reexamine our procedures for the dissemination of information and its use by practitioners as well as by scientists. I am pleased to report to the committee that medlars went into operation in December 1963. With the aid of the computer the Janu- ary issue of Index Medicus was produced on schedule. In addition to Index Medicus, medlars has the potential to handle 37,000 specialized demand searches of the literature each year. capabilities It is capable at the same time of producing 150 selected recurring bibliographies on a weekly, monthly, or semiannual basis. Whereas the task of indexing the world's biomedical literature must be cen- tralized for medlars input, its retrieval capacity, however, can be augmented by decentralization. Duplicates of medlar's tapes can be searched by other computer cen- ters, thus multiplying the power of medlars many times. We are therefore requesting $250,000 to convert our magnetic tapes and to reprogram our material for use by different equipment available in universities with strong libraries and computer programs.0067051_000007.txt

Page  7 1058 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS The other activities of the national library have increased appre- ciably during the year. Senator Hill. Excuse me. Is that $250,000 in your budget? Increases in Services Dr. Cummtngs. Yes, sir; it is included in our budget request. Our reference requests have increased by 30 percent. The number of readers visiting the library has increased 86 percent. The number of reader requests which we could fill has increased 49 percent. Interlibrary loans have increased 19 percent, and the number of articles sent to physicians and scientists through photoduplication has increased by 20 percent. I believe this reflects a real thirst for knowledge and information on the part of our medical community. Our acquisition program has continued its work of keeping the library's collection up-to-date on a worldwide basis with the addition of 84,000 new items. These significant increases in services have been provided despite the fact that the National Library of Medicine has had a net increase of only seven positions during the past 15 years. Publications Support Program In the library's extramural activities, its publications support pro- gram last year was given the assignment of serving as a principal resource within the Public Health Service for improving the inter- national exchange of scientific medical information. This program contracts for the production of bibliographies, ab- stracts, translations, directories, and other library reference tools. The foreign publications program, using Public Law 480 funds, op- erates principally in Poland, Israel, Yugoslavia, and hopefully next year in India. We support the production and translation of scientific documents of interest to the American medical community. The National Li- brary of Medicine intends to work closely with other elements of the Public Health Service in the development of new action programs designed to improve the delivery of scientific information to keep pace with the increased production of scientific knowledge generated by research. Cooperation With Medical Libraries In the same way we plan to work closely with our Nation's over- burdened medical libraries so that we may be able to assist and sup- port their efforts to provide medical information to students, to teachers, and practitioners of medicine who need and desire this in- formation. Thank you, Mr. Chairman. Performance of Medlars Senator Hill. Doctor, I was interested in what you had to say about medlars. Are you satisfied with the performance of medlars at this point? Dr. Cummtngs. Senator Hill, I believe we are quite satisfied with the system's design and the potentialities of medlars. I am not completely satisfied, however, with our indexing input, because I believe that the0067051_000008.txt

Page  8 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1059 size of the staff is too small to adequately analyze all of the world's biomedical literature. Also, I believe that we must refine further the medical subject head- ings which are used to organize medical information for access by various disciplines. I believe our experience to date, however, would reinforce the hopes and aspirations for medlars which have been ex- pressed to this committee during the past 2 years. Senator Hill. I believe the House added $180,000 to your budget. Dr. Cummings. That is correct. Senator Hill. And some nine positions. Are any of those positions or those funds going to your medlars operations or other operations? Program for Research in History of Medicine Dr. Cummings. No, sir; the House allowance providing $180,000 and nine new positions is to establish a new program for research in the field of history of medicine. This will permit us to catalog the magnificent collection of historical documents which resides in the national library and make access to this collection easier for physi- cians and scientists who wish to use it. It will also provide support for studies by medical scholars in their own libraries. Senator Hill. To carry forward the program for medlars as you suggest here, how much more would you need ? Dr. Cummings. It is my view that the principal needs are for indi- viduals who have scientific backgrounds coupled with a knowledge of foreign languages. analyzing and inputting biomedical literature At the present time our input into the medlar system is running at a level of 150,000 articles per year. The total world's biomedical literature is estimated to be about 250,000 scientific articles per year. Thus, I believe we would require an increase of approximately $250,- 000 to attempt to meet this total need of acquiring, analyzing, in- putting, and retrieving more comprehensive citations to the medical literature. Senator Hill. Was this matter presented to the Budget ? Dr. Cummings. No, sir; this matter was not presented to the Bureau of the Budget. Senator Hill. Did you present it to the Department ? upgrading staff Dr. Cummings. The Department was requested to provide an in- crease of about $850,000 in our original budget estimates. The prin- cipal use of these funds, however, would not have gone toward the increasing of our staff for input into the medlars program. Senator Hill. But the Department didn't go along with the addi- tional $850,000? Dr. Cummings. I believe we were given an allowance of approxi- mately half that amount, but I would like to look into the precise figure here. Senator Hill. You can check that and supply it for the record, if that will be satisfactory. Dr. Cummings. I would be very pleased to do that.0067051_000009.txt

Page  9 1060 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS (The following information was later supplied:) A review of the fiscal year 1965 budget history reveals that the NLM requested increases of $857,000. This was reduced to $619,000 by the Public Health Service. The Bureau of the Budget reduced the amount requested by $177,000. Programs Authorizations Senator Hill. All right. By virtue of the House action and the Comptroller General's ruling of March 4, 1964, you have some addi- tional authorities for programs, do you not? Dr. Cummings. Yes, sir. It is my judgment that the entire Public Health Service has clearer authority'for support of research and train- ing in the area of medical communications. Senator Hill. In terms of the budget before us, is that budget adequate to initiate the new activities under these new authorities? Medical Librarians Dr. CumminOs. In my judgment the present budget proposed for the National Library of Medicine is not adequate to implement the new authorities which are available to us. For example, Senator Hill, our Nation each year trains only 30 medical librarians. We estimate that the need for training librarians exceeds this amount at least tenfold. r There are more than 5,000 hospital and medical libraries, but the total national manpower to run these libraries profes- sionally is limited to 1,200 individuals. Thus, we have essentially one professional librarian for every four medical libraries. I believe there is a great need in this particular area. Senator Hill. What would you provide ? Additional training and fellowship programs ? Dr. Cummings. I believe that new training programs must be estab- lished for the development of medical librarians and that we should establish retraining programs for those who are available. Librarianship is changing with the advent of electronics and new mechanisms for handling the literature. Thus I believe that research is just as important as training in adapting libraries to contemporary technology. Mr. Kelly. Mr. Chairman, I winder if I might comment on the question of what was requested. Senator Hill. Go ahead, Mr. Kelly. Budget Request for 1965 Mr. Kelly. I think some of our concern is that we have been work- ing so hard on the 1966 budget that we are somewhat confused as to what we asked for 1965, out the Public Health Service asked for $3,810,000 for the National library of Medicine for 1965 and the Secre- tary supported this and submitted that. Senator Hill. How much? Mr. Kelly. $3,810,000 in total. The Secretary supported this re- quest and submitted it to the Director of the Budget Bureau and the President submitted a request to you for $3,633,000. Senator Hill. A reduction of $177,000.0067051_000010.txt

Page  10 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1061 Mr. Kelly. $177,000 and the largest part of that cut was $170,000 related to the medlars project and I think it was a reduction in the number of decentralized demonstration projects. They allowed $250,000 to endeavor to develop this concept of decentralizing medlars. Regional Library Studies and Resources Senator Hill. What do you contemplate under regional library studies and resources, Doctor ? Dr. Cummings. Mr. Chairman, we believe that there should be a comprehensive, very carefully designed feasibility study to determine whether we can share our Nation's information resources through the establishment of a network of regional libraries. This matter has been under study in the National Library for several months and it is our view that the importance of the issue calls for an objective outside group to analyze and evaluate the problem so that we may develop realistic program plans. Senator Hill. Would you need additional legislative authority? Dr. Cummings. No; I do not believe we would require new legisla- tive authority for such a study. Senator Hill. Do you need any additional legislative authority for any of the programs that,you might contemplate or might at this time be thinking in terms of ? Dr. Cummings. It is my judgment that the Public Health Service has adequate legislative authority for support of research and training aspects of library needs. I believe it does not have adequate legis- lative authority for construction of new medical libraries and for the support of resources within these institutions. New Library Construction Senator Hill. When you speak of new library construction, are you thinking in terms of what we might term "regional libraries?" Dr. Cummings. I think we have two sets of needs and two ap- proaches. One would be to build upon existing centers of excellence and create regional libraries, built upon existing plans to provide regional services. I believe that, in certain portions of our country where such' centers of excellence may not exist, it will be necessary to create entirely new structures and organizations to serve as regional libraries* > Medical Television Senator Hill. Doctor, is television being of much help today in this matter of dissemination of medical knowledge and information ? Dr. Cummings. I am not sufficiently well informed on that subject to answer your question definitely. Senator Hill. They had a conference in Atlanta, Ga., and I think it was the Communicable Disease Center there where it was held, of those who were interested in what we call medical television. I just wondered what progress we were making along those lines. Telefax Dr. Cummings. In the potential use of such devices for library pur- poses there is a growing body of information which suggests that0067051_000011.txt

Page  11 1062 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS telefacsimile, which incorporates the principles of television, may in- deed be one of the future mechanisms of disseminating scientific in- formation at great distances. Actually, one might display, for ex- ample, the holdings of the National Library of Medicine to distant smaller libraries. It is my view that such developments are probably going to be avail- able within the next several years. Similarly, we believe that the traditional methods of acquisition and cataloging of the vast numbers of documents can be aided by computers so that libraries may process and search documents through such devices. Publications and Translations Senator Hill. What about your publications and translations? How is that program getting along ? Dr. Cummings. I think this program is going very well, Senator Hill. It is a small program, but it is highly selective. We believe we should keep it a small, selective; high-quality program. We em- Imasize, as you know, the translation of the Russian and Japanese iterature into English so that it may be useful to physicians and scien- tists in this country. Senator Hill. Did the budget allow you pretty much the funds you asked for for this program ? Dr. Cummings. Yes, sir; I believe the full allowance was provided. Senator Hill. Senator Byrd ? Senator Byrd. No questions. Senator Hill. Doctor, we certainly want to thank you very, very much. If you should have any further thoughts or suggestions we would be glad to have you address a communication to us. Thank you very much. We appreciate your statement. Dr. Cummings. Tnank you. Senator Hill. I don't think there is anything more important here than to get this knowledge and information, as you said, out to our schools, and our students, and to our practitioners, to the doctors themselves. Dr. Cummings. Thank you. (The following additional information was later supplied:) Department of Health, Education, and Welfare, Public Health Service, Bethesda, Md., May 28,1964. Hon. Lister Hill, U.S. Senate, Washington, D.C. Dear Senator Hill : I appreciate the opportunity you afforded me during the hearings on the National Library of Medicine budget to send you further infor- mation relating to the problems of the library and other medical libraries throughout the country. Over the past few years the National Library of Medicine has been challenged as never before in its 130-year existence. The challenge arises from the tre- mendous increases and advances accomplished in fields of medical research education, and practice, and the disparity of information resources available to support and maintain these advances. Expressed in its simplest terms our Nation's medical libraries have been on a starvation diet for years and sud- denly are being asked to do the work of a hundred Goliaths. With its limited resources, the National Library of Medicine has reacted to this challenge by developing the medlars system, and by establishing an extra- mural program designed to strengthen the functions of other medical libraries0067051_000012.txt

Page  12 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1063 through which the National Library of Medicine services its national public. At the moment the potential of these programs in answering the challenge has not been fully realized. They are both of recent vintage, and funds for their full development to a point where they can be effective have never been re- quested formally. We believe that the National Library of Medicine, which maintains the great- est resource of scientific and medical documentation in the world, has developed sound plans for assuming national leadership, with programs designed to solve the medical information crisis. This library constitutes a principal logical instrument through which such national needs can be met. In the recent past the Board of Regents of this library and the National Advisory Health Council have expressed their awareness of the magnitude of the problem and have called for the development of action programs. On April 2, 1964, the National Advisory Health Council reaffirmed its concern with the urgency and seriousness of the problems facing our Nation's medical libraries and offered the following reso- lution to the Surgeon General of the Public Health Service. Resolution of the National Advisory Health Council "The National Advisory Health Council reiterates the concern which it has expressed on previous occasions with reference to the deteriorating conditions of the medical libraries of this country. The conditions referred to in our previous recommendations have become increasingly acute. "The magnitude and complexity of medical literature generated by the research of recent years and necessary for the maintenance of excellence in teaching and practice have overwhelmed existing processes and organiza- tions for handling biomedical information. "The broadening base of medical research and practice, calling for litera- ture from numerous ancillary fields, has added to the complexity of the problems faced. "The actual physical deterioration of that portion of the medical litera- ture which has been published on interior paper is threatening the libraries with a loss of important medical information. "The lack of personnel adequately trained to deal with the problems of medical libraries become increasingly evident. "The inadequate space and facilities to house the multiplying volume of literature and to provide work areas to utilize effectively the library re- sources seriously hamper the research, training and service efforts of the medical community. "The relative support of medical libraries has been steadily diminishing under the pressures of the rapid development of other programs and activi- ties of medical institutions, most of which make increasing demands upon the library. "These factors have added to the critical character of the problem. Since the medical library is, and will continue to be, the principal mechanism for collecting, managing, and disseminating medical literature, the deficiencies of our medical libraries constitute, in our judgment, a critical situation which requires immediate remedy. "The Federal Government has long given significant support to medical re- search and training. It is our conviction that the vital functions of the medical libraries will not be adequately performed without substantial assistance from the Federal Government. "The Federal Government has established the National Library of Medicine which constitutes the largest collection of medical literature in the world and which is developing new systems and methods for the organization, handling, and dissemination of medical information. This institution must play a leading role in the endeavor to meet these problems: Therefore be it "Resolved, That the Surgeon General be urged to utilize existing authority and to seek such additional legislative authority as may be needed to accomplish the following as effectively and as rapidly as possible: "(«)To provide for the establishment and maintenance of a limited number of regional libraries linked to the National Library of Medicine to provide and develop an effective instrument for regional service. "(6) To enable the National Library of Medicine to provide a program of education and training for medical librarians and information specialists (in- cluding retraining programs) in order to increase the number of qualified per- sonnel.0067051_000013.txt

Page  13 1064 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS "(c) To enable the Public Health Service to support library facility construc- tion, including new facilities as well as expansion, alteration, renovation, and equipping of existing facilities. "id) To provide for the central library (National Library of Medicine) the funds and personnel necessary for effective leadership in this national program and for improving and making available more adequately its unique resources and services to the medical community. "(e) To enable the National Library of Medicine to conduct and support a program of research designed to improve systems and methods of handling medi- cal literature, including new techniques of indexing, coordinating, abstracting, translating, and reviewing biomedical literature." I am in complete agreement with this expression of concern and the recommen- dations calling for program development and actions designed to meet these needs. The special report which is attached to this letter reveals the state of our pro- gram plans and program development. I estimate that additional funding in the amount of $2,750,000 (over the House allowance) would be required to launch these programs during fiscal year 1965. Ultimately we estimate that these programs will require $100 million to be spent over a 5-year period in order to meet the accumulated and urgent national needs for medical library systems capable of efficiently bringing medical information to the physicians and scien- tists who need it. Should you or your staff require further information about the scope and magnitude of these national needs and our plans for meeting them, I hope that you will not hesitate to call me. Sincerely yours, Martin M. Cummings, M.D., Director, National Library of Medicine. Special Report Summary.—Additional funds required by the National Library of Medicine in fiscal year 1965 over original estimate Positions Funds Intramural: Medlars........_______ NLM resources........ Graphic image studies.. Subtotal, intramural. 19 Extramural: Training and fellowships__________________________......_______..... Regional library complexes and resources____........................... Research and development.............................................. Publications and translations.............____............________..... Program direction, review, approval, and administration of grants and contracts_____________________________________________._________ Subtotal, extramural____________ House allowance for history of medicine. Total required over original fiscal year 1965 estimate. Total required over House allowance_____........... $120,000 70,000 60,000 250,000 600.000 500,000 1,000,000 150,000 250,000 2.500,000 180,000 2,930,000 2,750,000 INTBAMUBAL PROGRAMS OF NLM Of all the Federal libraries, the. National Library of Medicine has unique responsibilities to its national community. The Hill-Kennedy Act (Public Law 941) enjoins on the library responsibility for making its facilities available for research, and its bibliographic, reference, or other services available to public and private agencies and organizations, institutions, and individuals The library's success in implementing this mission has earned for it in the words of a recent study on the "Future of the Research Library," a reputation as the "most conspicuous example of a national backstop to local library resources in a specific subject." The attention devoted to the development of science information systems in recent years has added a new dimension to the national service responsibilities0067051_000014.txt

Page  14 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1065 of the National Library of Medicine. No longer can the library be viewed solely in terms of a conventional research library. Rather, it acts as a gigantic infor- mation resource to which all specialized information systems, so necessary to the progress of research, must sooner or later relate. With its world-renowned resources there comes a new dimension to its national responsibilities to special- ized information centers, as well as to conventional libraries. iWith its medlars system it has assumed national leadership through the develop- ment of the largest electronic document retrieval system yet devised for any area of science. These changes have come about so rapidly that the planning of 5, or even of 3, years ago, when medlars was conceived, is already outmoded. The National Library of Medicine is thus faced not only with challenges and program opportunities which were unforeseen at the time of its preliminary budget submission for fiscal year 1965, but also with deficiencies which must be corrected if the library is to make an adequate response. These deficiencies exist in two principal areas: resources for the development of the medlars sys- tem, and resources for the development and maintenance of the library's collections. Medlars Development The equipment and the computer programs of the medlars system were designed to accommodate an annual input of 250,000 citations to the scientific medical literature. At maximum productivity, the 18 indexers envisioned in the 1965 budget submission can produce 160,000 citations. However, the library's expe- rience has demonstrated that the earlier productivity targets must be adjusted downward if the library is to meet requirements for the scientific excellence of its indexing imposed by medical research. Quantity will necessarily be sacrificed for quality. The medlars system has a machine capacity for performing 100 searches per day. However, the search questions received in the library must be carefully analyzed and converted to logical forms understood by the machine by employees known as searchers. Experience has shown that each searcher, working full time, can formulate an average of 5 searches per day; the 1965 budget calls for 9 searchers, whose total daily production cannot exceed 45 searches. Thus the library is faced with the dilemma of having the world's largest information retrieval system and enough manpower to operate it at less than 50 percent of its capacity. Faced with these problems, the National Library of Medicine has resorted to a series of temporary expedients through agreements and understandings achieved with other public and private agencies. Thus the Veterans' Admin- istration has detailed three persons to assist in searching the literature; the American Dental Association has agreed to provide additional indexers, privately funded, to assist the library during this period of emergency. These temporary expedients are uneconomical in that personnel turnover is rapid and training efforts major. The library has a requirement, therefore, for eight positions, three of which relate to increased indexing input, three to increased searching capability, and two to training and research. The additional amount required is $94,000. In addition, six additional positions and $26,000 are required to provide for the conversion of the increased indexing input for its machine process- ing in medlars. Library Resources The literature-collecting policies and practices of the National Library of Medicine are being challenged as never before. In its past history, medicine could be defined in terms of disciplines and fields of specialization. The bio- medical sciences today are in the middle of what might be termed a violent interdisciplinary revolution and are becoming more dependent on the physical sciences on the one hand and the behavioral and social sciences on the other. This means that the classic definition of "medicine" which served the library well in the past as a base for its collecting policies has become narrowly restrictive. The library has already moved to acquire necessary publications in chemistry, physics, mathematics, and in the behavioral sciences, and must continue to broaden the base of its collecting policies. Needs for such development are conspicuous as the library moves to support the building of resources in specialized information centers established by other programs of the Public Health Service. These specialized information centers exist in interdisciplinary areas such as brain research, diabetes, Parkinsonism. Each of them is turning to the National Library of Medicine for photoduplication service to build selective collections for areas of interest. With increasing0067051_000015.txt

Page  15 1066 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS frequency they are calling on the library for materials hitherto considered outside the library's scope. If the library is to discharge its mission to backstop infor- mation centers in the same terms that it backstops medical libraries, it must move to acquire the literatures of fields now considered closely related to medical rp^Afl roll For these purposes, five additional positions and $70,000 are required. Another challenge exists in the planning of networks for the optimum relation- ship of medical library resources, local and regional, to these specialized infor- mation centers. A preliminary study supported by the library has suggested the possibility of designing an economically feasible national system of medical libraries and information centers interconnected with each other and with the National Library of Medicine by electronic communication links. Telefacsimile could be used, for example, to provide for economic access to library resources required by specialized centers. Similarly, such linkage would afford opportuni- ties for the development of scientific television programs and related new com- munications media. The possibilities are exciting, but careful assessment should be made of the needs and purposes of such a system. History of Medicine Related also to the development of resources is the new program of the Na- tional Library of Medicine for the better organization of its collections in the history of medicine, and the encouragement of scholarly studies facilitated by this action. For this purpose the House Appropriations Committee has approved an increase of $180,000 in the library's budget (including $60,000 for intramural programs and $120,000 for extramural programs) for fiscal year 1965. This action, if sustained by the Senate, will enable the library to exploit the scientific and cultural values of the earlier literature for their benefits to the American society. Toward a Graphic Image Stobage System Proposals for revolutionizing the research libraries have frequently stressed the desirable miniaturization of their collections for purposes of storage and more rapid retrieval. To these motivations the National Library of Medicine adds a third. If the library is to continue its archival function for the American society, it is imperative that more permanent means of storing the literature be explored. Recent technical studies have demonstrated that the paper on which the library's books and journals have been printed since 1870 has a limited technical life expectancy. Over 5 million pages of the library's collections have lost their original strength, and under conditions of use will disintegrate. Over the past 6 years the library has been conducting a modest "poor paper" project for the purpose of microfilming journals which are falling apart. This problem, in association with the opportunities for providing a mechanized retrieval system for the miniaturized photocopies in relation to the medlars system, requires a sophisticated systems study. There is urgency, since the rate of technical de- terioration of the paper far exceeds the rate of photography for preservation of the collections. To undertake such a study in fiscal year 1965 the library would require an additional $60,000. Thibd Generation Retbieval Systems The medlars system, as it was initially conceived, had two objectives: the establishment of a centralized operational system within the National Library of Medicine, and the extension of thia system through decentralization to uni- versities throughout the country. These two objectives may be conceived of in terms of a first and a second generation of medlars. The library is faced with increasing challenge to continue its pioneering effort and to design what might be called a third generation system. A fundamental characteristic of systems design during rapidly developing electronic technology is that at some point in time the design must be frozen in order that the system may be developed. The medlars system is derived from the state of electronic technology as it existed in 1961. In this brief period of time, the industry has developed rapidly, and there are many technical advances and promises of future ones. For example, random access equip- ment, just coming on the market 3 years ago, would now give the medlars system immediate access to 3 billion characters, which represents 6 times the storage capacity possible with the 35 tapes required for a 5-year store.0067051_000016.txt

Page  16 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1067 Possibilities of machine scanning of the titles and text of the medical litera- ture (so-called character recognition) are exciting. In addition, the library has gained unique experience in the development and operation of the largest system yet created for the storage and retrieval of the published scientific literature. Multiple possibilities are opening up. For example, the computer systems using medlars tapes throughout the United States could be linked by data transmission lines to the library, so that information retrieved from medlars could be displayed in multiple localized centers throughout the country. Or local hospitals could be linked with the regional computer and library centers through facsimile devices which would permit the transmission to them of pages of medical text. Other developments suggest that library card catalogs can be replaced in the future with a combination dial and console display system. The National Library of Medicine believes that its function of national lead- ership in this field will not permit it to remain fixed with its present system. It will attempt, over the next few years, to encourage independent research and development projects which may relate to the ultimate design of a third generation of the medlars system. It is also engaged in developing a research potential among its own staff, so that more information and experience will be available to assist in the development of such a system. It is not making a specific request for additional funds at this time, but will be preparing itself for a broad-scale attack on this problem in the future. Extramural Program Plans of NLM The medical library constitutes a central and essential mechanism to which other biomedical communications systems ultimately relate. As an important facet of the total biomedical communications complex, the National Library of Medicine is concerned broadly with the collection, preservation, strengthen- ing, and utilization of the scientific record. The National Library of Medicine is concerned specifically with systems for the cataloging and resynthesis of scientific publications and with systems for the storage and retrieval of the published scientific literature. It is concerned also with experimental activities relating to such systems and with the strengthening of the present capabilities of established methods. Inasmuch as communication is an integral part of the research process, communication inadequacies threaten the quality of biomedical research and medical care which are dependent on its findings. While the free communication of research findings is essential to the research process, the programing strategy in the communications field during the next dec- ade cannot be limited to fulfilling the needs of the research community solely. If the purpose of the research expenditure is to be completely realized, the results of the research program must be carried not only to other investigators but to graduate students and medical students, residents, practitioners, and interested elements of the public. The communications network must develop a capacity to serve three medical areas—research, education, and practice. Communica- tion of biomedical information is in a real sense a research tool, but of itself it is an educational process, and much research needs to be done on the process itself. Medical Library Needs—General Considerations Numerous studies have highlighted the fact that the Nation's medical libraries are woefully inadequate in almost every respect. The demand which bio- medical research has placed on the systems is clear, but little has been said of the impact the changing educational systems are having on libraries and information systems. A U.S. manpower goal for 1970 looks forward to a dou- bling of the number of research workers. With the constantly expanding body of knowledge, as well as newly emerging medical scientist career patterns, concepts of medical education and curriculums are undergoing change. Whether the student becomes an investigator, teacher, or practitioner, he will pursue a program of continuing education never before required. The newly developing medical schools will materially add to the demand for additional personnel and lor servicing by regional facilities and the National Library of Medicine. Many established, as well as newly developing, schools have a concept of the medical school library as a learning resource center interrelating as a 30-s»r»2 ii4- i.t. 2-----20067051_000017.txt

Page  17 1068 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS central and/or switching point with other libraries (i.e., affiliated hospitals, departmental, university, etc.) and with specialized information centers in_the processing and handling of information. Many medical center planners view the modern library as a proper repository for all types of educational media of general use and include facilities for the acquisition, storage, retrieval, and use of such other media as films, fllmstrips, microtexts, audio discs or tapes, and other newer informational materials. In spite of the recognized need and importance of the library, a study pub- lished in 1963l revealed that fewer than 25 percent of the Nation's medical school libraries met the suggested minimum standards for number of volumes, and only 25 percent approached the minimum standard for periodicals being received. With the continuing increase in literature output, as well as increas- ing costs, each year which passes without appropriate support for library activi- ties compounds their deficiencies. In addition, it is essential that qualified individuals perform the services basic to the library and communications systems that are evolved in meeting the needs of highly developed scientific research and educational programs. Manpower studies thus far indicate a grossly inadequate number of librarians, inadequate programs for training in medical librarianship and research librar- ianship. a dearth of documentalists in the biomedical field, and only a handful of institutions capable of providing the sort of training needed to carry out the services required. Further, there are serious problems in the preparation of publications! and in repackaging of the information which is presently available to us. It is clear that we have not employed and deployed the capability and technology available to us now in the communications field generally, or specifically in the area of publications, indexing, abstracting, and translations. Since the National Library of Medicine holds the world's largest collection of historical and current medical documents, it is also an instrument of the historian and scientist who pursues scholarly work related to the health sciences. A thoughtful, integrated, and generally imaginative program of support must be initiated in at least four major areas: (1) Training programs for the necessary manpower to exploit present capa- bilities to the fullest, as well as to meet present and future requirements for the technical advances in library-based communications methodology; (2) Research and development studies of regional and local library networks and the national logistics of an adequate library-based biomedical communica- tions complex with adequate support for resources; (3) Special research programs directed at more clearly relaying research findings in an accessible and useful form to the user, whether he be investigator, teacher, student, or practitioner; and (4) Direct support for the strengthening of existing media for the secondary publication of biomedical information and the promotion of new or experimental forms. I. Training Pbogbams and Special Library Fellowships Long-range program planning depends upon the quantity and quality of man- power being developed. It is clear that there is a serious need for a broad spectrum of individual capabilities in the library-related biomedical communica- tions field and that the resources for providing the necessary range of training experience are at present extremely limited. The NLM-supported training programs will have the dual purpose of (1) strengthening the performance of existing components, such as medical libraries, and (2) developing qualified personnel for emerging systems. A greatly expanded pool of highly trained manpower for managing the pub- lished record is obviously needed. The first problem, namely that of providing increased numbers of qualified, traditionally trained biomedical librarians, conceivably could be dealt with by strengthening and increasing the capacity of existing training centers and developing new centers. The training of librarians qualified to staff biomedical libraries, as they exist today, is presently carried out in 9 of the existing 31 schools of library science in the country. The pat- tern for training professionally prepared biomedical librarians involves work Libraries In the United p. 145.0067051_000018.txt

Page  18 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1069 toward the M.S. or Ph. D. degrees in library science, including a specific course in medical librarianship of varying duration and quality. Additionally, a very limited number of internships are available. It is this nucleus of facilities and pattern of training that would form the base for developing new and stronger programs. Highest priority should be assigned to the training of individuals for careers in the academic aspects of biomedical librarianship, i.e., for the staffing of the training centers themselves. The solution of pressing problems in the manage- ment of the published record requires a group of individuals capable of provid- ing not only first-rate service of a highly specialized nature, but capable of solving problems in biomedical librarianship through the conduct of their own research. Such training would be most effectively done in the academic setting provided by the school of library science where facilities of the university as a whole would be available to contribute faculty expertise in modern librarian- ship, engineering, systems analysis, science, and management to formulate an extensive interdisciplinary approach to training. If the librarian of the future is to assume an appropriate role as a key faculty member in the structuring and coordination of scientific communications networks for the health profes- sions, an appropriate educational background at the graduate level is a pre- requisite. The enhancement of a library science career in this manner would undoubtedly have a salutary effect on recruitment of promising young people to the field. The needs for personnel for direct service are of such magnitude, however, as to demand early and vigorous action. It is estimated that more than 3,000 pro- fessionally qualified biomedical librarians are needed now in order to provide 1 such person in each existing medical library. Presently the majority of the medical libraries are staffed by many individuals lacking adequate background to meet the needs of the scientists and practitioners using their resources. Only 35 additional medical librarians are being trained annually. With the rapid advances being made in the management and processing of biomedical information, many medical librarians currently practicing their pro- fession find that they are not able to take full advantage of these new tech- niques because of deficiencies in their training. In order to utilize this pool of trained manpower to the fullest in the future, it will be necessary to inau- gurate programs for retraining librarians in new developments in the field. It is reasonable to hope that traditional methods for training biomedical librar- ians and other personnel involved in furthering the work of the library will be critically examined in the future and new courses and expanded curriculums developed. Support should be extended to those institutions wishing to conduct serious experimentation to arrive at more thorough and effective training plans. The biomedical library, as a large and essential component of the scientific communications complex in the future, will require a type of individual who has not existed in the past, the information scientist or specialist. The needs for the special skills which such individuals must possess have been recognized only in recent years. The training of the specialist is highly interdisciplinary in nature. He may enter his period of training with a baccalaureate degree in mathematics, science, or language. His area of concentration in pursuit of the graduate degree could be heavily weighted toward the biomedical sciences with subsidiary course work and research in the library or communications field. Conversely, he could specialize in these latter fields if his background were particularly strong in the sciences with somewhat less attention to them in his graduate career. At the completion of this training, the specialist would be qualified to serve professionally as a technical literature analyst in the biomedical library in relatively large and active scientific centers. The use of computers and advanced systems in the processing of large volumes of information has given rise to acute needs for additional personnel of varying backgrounds to serve as indexers, programers, searchers, abstracters, etc. Train- ing programs for individuals entering this area of information processing tech- nology differ from those of the medical librarian and the biomedical information scientist in that they may be conducted by means of short courses, seminars, and institutes. This may take place outside the ordinary degree-granting channels of academic institutions. Well-trained information processing technologists are a most vital link in information storage and retrieval systems and the success of any such system is directly dependent upon the quality of work performed by them.0067051_000019.txt

Page  19 1070 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS The production of manpower capable of managing the editorial work and scien- tific writing necessary for the compilation and resynthesis of biomedical infor- mation is a necessary adjunct to the biomedical library field. Training programs for sicentific writers and editors should be centered in schools of journalism with opportunity for students to participate in scientific work in cooperating de- partments offering the traditional training in science. An extremely significant role in the effective transmission of highly complex and sophisticated research information to the medical practitioner will be played by competent people in this field. One of the aims of the National Library of Medicine is to further scholarship in the development of research monographs, critical reviews, bibliographies, and historical studies. To accomplish this objective, it is highly desirable to foster training programs in the history of the life sciences. It would be most unfortu- nate for the acute problems of today and tomorrow with regard to the biomedical information resources to cause us to neglect what has gone before. The reexam- ination of the published and unpublished record of the past may yield much overlooked data of value to the current researchers and practitioners in the health sciences. The mechanisms to be used to support the various activities described above will include the graduate training grant, the traineeship, the research fellow- ship at the pre- and post-doctoral level, the special fellowship, and the contract as appropriate. It should be emphasized that these are initial plans and identify generally areas of fundamental interest. A training program of quality and strength is considered a keystone of the total extramural program effort on both an im- mediate- and long-range basis. (Because of the necessity for advanced planning and recruitment of trainees, training grants throughout the Public Health Service are on a "forward financing" basis. For this very practical reason, programing should not be delayed unduly.) special library fellowships One medical information requirement upon which nearly all elements of the medical community are agreed is the need for high quality critical reviews. The present quality of reviews does not nearly meet the requirement, and improve- ments in these would significantly strengthen the information interchange process. Part of the problem involves the nature of the critical review, which is a lengthy paper or book summarizing, synthesizing, and evaluating scientific find- ings in a particular discipline or field of scientific interest sometimes over an extensive period of time. In a reasonably typical effort, the person preparing a critical review may study as many as 1,000 scientific documents or more, cover- ing a period of 20 years or longer. Assuming the job is properly done, the review can be of inestimable value to students or other scientists in that field in under- standing the contents of great segments of literature and developing a valuable perspective of the field or discipline. The work is best performed by a scientist of appreciable note and accom- plishment in the field under review. If a scientist is considered adequate for such an undertaking, it is probable that he is actively involved in research and thus not enthusiastic about leaving his laboratory or clinic to undertake study and writing for a year or longer. A prerequisite in acquiring scientists to undertake such work is a salary which matches or comes close to their current income. They also must have clerical assistance and easy access to large segments of the biomedical literature A small number of distinguished scientists can be found for such work The aim of this segment of the program would be to give them the salaries and resources necessary. It is also planned that at the election of such scientists resources will be provided within the National Library of Medicine itself so that they could have easily available the literature they need. II. The Regional Library Complex beseabch and besoubces The major problem of medical librarianship in the United States todav i« nr« of acquisition, storage, and access. These relate directlv to the task of +vl library in making available to the scientist, teacher, student, and physician the0067051_000020.txt

Page  20 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1071 documents or items of information responding to their needs—and in the shortest possible time. In consideration of the worldwide production of 22,500 pages of new medical material every working day of every year, the task of acquisition becomes one of such massive proportions as to challenge the capacities of nearly all medical libraries. In the United States, only the National Library of Medicine collects medical literature on a comprehensive worldwide basis. This is in the interest of assuring that the biomedical scientific record will be maintained on as com- plete a basis as possible for the sake of nearly all medical information needs irre- spective of frequency or degree of interest. But the gap between NLM, serving as a libraries' library on the one hand, and the capacities of most of the Nation's other medical libraries on the other hand, is too great in terms of time, distance, the adequacy of collections, and the speed and efficiency of access. Critically needed is an intermediate level of regional medical libraries estab- lished in a national network in relation to the National Library of Medicine and the local medical libraries. Local medical libraries have needs exceeding their capacities as a result of the expansion of medical information needs and the requirement for new and different types of medical literature. Even were NLM able to meet the local library needs in terms of subject matter, the problems of time and distance would be met with greater efficiency and effectiveness by a local library network. Appreciable economies also would be effected by per- mitting regional libraries to acquire those relatively special materials which are important to medicine but which are less frequently used. While the vast major- ity of local medical libraries must improve their resources, the regional libraries would relieve them of the need for expenditures on infrequently used infor- mation. LONG-RANGE PROGRAM DEVELOPMENT PLAN After carefully studying the regional library need, NLM is convinced that its approach in developing this program should be in two forms. The first would be through grants in funds and/or materials to strengthen regional resource centers on existing bases of library excellence. The second would be for the National Library of Medicine to make direct expenditures for the construction, staffing, and equipping of regional libraries, which as branches or extensions of the National Library of Medicine would be Federal institutions. INITIAL PROGRAM PLANS The experience of the National Library of Medicine in making its holdings of the scientific literature available indicates the extensive interlibrary activity that is taking place. A total of 536,894 photoduplication orders were filled in a 5-year period ending in fiscal year 1963, representing more than 8,500,000 pages of printed biomedical material that was sent to requesting institutions. While it is essential that a sufficient number of individual medical libraries be brought to at least a minimum standard, the phenomenon of uncoordinated development of conventional libraries is approaching obsolescence. The role which the regional library can fulfill in the structuring of optimum systems for providing extensive coverage and easy accessibility to the literature by the user has not been adequately assessed. The development of the concept will involve the reinforcement of a given number of libraries as major repositories, but the strategy of selection of locus and the logistics of regional and interregional or national networks needs extensive study. The relationship of the local to the regional resources requires careful research, along with experimentation in the use of modern techniques available to facilitate the storage and retrieval of the information and research on conventional and nonconventional systems for pro- viding basic library services. A research and development program to investigate the nature of the regional concept and develop the approaches which emerge from the more promising re- search projects and operations research in this area should be initiated. In addi- tion, grants would be used to bring the resources of the selected libraries to a high level of effectiveness to serve their particular areas. The program would take economic advantage of the existing collections of the selected libraries and take advantage also of their already established services to other nearby libraries. Grant funds could be used for (1) books and journals; (2) cataloging, etc.; (3) equipment; (4) introduction of new technologies; (5) mechanisms (such as0067051_000021.txt

Page  21 1072 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS facsimiles) ; and (6) renovation. In the award of such grants, considerations in the establishing of priorities would include: (1) Need as determined by the levels of research, teaching, and medical activities in relation to existing library and other medical communication services; (2) The strength (in terms of collections, personnel, equipment, etc.) for existing potential regional library bases; and (3) Size and nature of regional population to be served. In order to study the effectiveness of nonconventional interlibrary relation- ships, a selected number of local medical school libraries in the complex must be brought to an optional standard of strength. A program of small developmental grants providing the components of supplies, including books and journals. equipment, personnel, and renovation is essential. A limitation to such grants is proposed, restricting them to a level not to exceed 40 percent of the library's total budget for the previous year and renewable yearly for a maximum of 5 years of support. Not only would this type of support be required in most instances to bring the local library to a level that would make its participation in the complex worthwhile, but the availability of such support would encourage the necessary cooperation of smaller groups, and the formula which has been devised would encourage the expansion of local institutional support. With the regional libraries purposefully located in geographical proximity to the local library complexes, the time of transmission of information through the mail or by messenger, from the regional libraries to the local libraries, should be greatly reduced. However, in response to the growth of demands for medical in- formation and the increasing speed with which it is required, electronic com- munication links must be developed for the transmission of information between the regional and local libraries as well. Such new equipment may be necessary in the future to assure that NLM can provide to the regional libraries copies of materials with the same speed and in something of the same manner that news photographs can be transmitted by wire or radio. It should be noted that the initial program described is a first step in the de- termination of the nature, location, and configuration of regional resources, the strengthening of regional resources per se, and the provision of very limited assistance in the strengthening of local resources. Research and development studies on the mechanics of the rapid automatic transmission of information be- tween the components of the regional system should be an integral part of the development of the network. This regional library aspect of the program should ultimately be broadened as suggested in the note regarding long-range program and also the provision of assistance for resources, both regional and local, must be made generally available. The initial program Will be experimental and exploratory, but will provide a sound basis for a major program effort in the future. III. Project Research The various categories of the extramural research and development program may be identified with problems of immediate or potential interest to the opera- tion of the National Library of Medicine and our Nation's biomedical libraries in general. An effort has been made to structure the program as a reflection of library-based or library-related information handling systems and the solution of problems encountered in the development of the functioning of such systems. While the projects of highest priority will relate to the practical problems of a library, an important consideration in the selection of projects for support will be the probabilitv of the general applicability of solutions or results to other biomedical libraries and the avoidance of support of approaches that have only limited local application. Most library problems are common to many, but solutions are frequently specific for the local situation: a requirement will be an identification of those principles and practices which may be extrapolated to other situations. For example, the research support program planned as an initial step envisions attention to three major areas fundamental to NL^I pro- gram interest: (1) access, (2) storage and retrieval, and (3) communication inclndiner transmission to the user. It should be stated at the outset that because of the nature of the research, both the grant and contract mechanisms of support should be available. l0067051_000022.txt

Page  22 LABOR-HEALTH,, EDUCATION, WELFARE APPROPRIATIONS 1073 A. ACCESS 1. Automatic indexing and abstracting Some of the major library tools for gaining access to the information available are indexes, bibliographies, abstracts, library catalogs, etc. In the preparation of indexes, a major concern and bottleneck is the input. Whether the indexer is a specialist in a given scientific field, or an individual without science background, there are problems of consistency and diligence. There is also a slowing of the system at the point of transfer of the work of the indexer to punched tape, cards, or other media. These two problems could be overcome if printed text could be converted automatically to machine language. Research on machine indexing, including character sensing and recognition, associative and statistical computer procedures is relevant to this particular problem. Research on automatic abstracting is another area Of considerable interest to NLM from the standpoint of its overall interest in the rationalization of the present extensive systems: for abstracting the literature of the biomedical sciences, as well as a possible future outgrowth of the medlars system. 2. Automation of library procedures Libraries, or rather the librarians who make them function, have evolved a, number of techniques for making recorded material available that have worked successfully for years. With the growth of literature, number of users, and dearth of librarians, the systems haye, in a sense, broken down. Applied research can be carried ou^ which, would lead to improved methods for the application of automatic data processing techniques to a number of library procedures, such as cataloging, the maintenance of the serial and circulation records. Thus the professional librarian's time could be freed for duties which require profession- ally trained judgment and for services more specifically directed to specialized needs. Further, with deliberate^emphasis on general applicability, and the means for standardization where possible, such automated techniques would form a basis for participation in more highly developed interlibrary relationships on a compatible basis and also a more specific and efficient access to information which might be held locally, regionally; or nationally. S. Research on terminology and cldssiftcation It is appropriate that NLM take the leadership in supporting studies of the problems relating to the standardization or coordination of classification systems in the biomedical sciences. Specific studies by specialist groups leading to the development of thesauri which would provide "in depth" classification, as well as current terminology, in specialized fields are needed. Through selective sup- port, the NLM can effectively encourage the degree of uniformity which is essen- tial if maximum access is to be gained to newly emerging disciplines or newly emerging relationships among disciplines are to be maximized. : B. STORAGE AND RETRIEVAL The subject of storage involves, in general terms, support for sL program of research and evaluation of' computer-based information storage and retrieval systems relating to library problems. There are two particular areas for research which have considerable significance for biomedical libraries. One is research on graphic image storage and retrieval. A solution of this problem would mean not only saving the great losses of the printed record, but the microreduction And storage of library materials would save storage space and enhance retrieval by the possibility of utilization of computers f6r search and retrieval directly1 from the stored material. Another quite different dimension of the storage question is the location of storage points, or more specifically,- items, in various interrelating repositories. This question has been discussed from the perspective of the regional library and the national logistics of. communications networks. It is equally important that the relationships on a more local basis be studied. For example, it would be important to study in great detail a medical school library as it relates to the uni- versity library and to the various special libraries or departmental libraries which exist on the campus. It applies as well to hospital libraries and special- ized science information centers from the standpoint of the location of holdings and the mechanisms for gaining access to the holdings of the units concerned and the dissemination of information in one way or another from those resources. A study designed to provide library service to the practicing physicians from an0067051_000023.txt

Page  23 1074 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS extensive geographical area within a State is needed. It would be clearly an objective of such a study to identify positive aspects of such situations as guide- lines for newly developing medical schools and developing medical school li- brary-university library relationships. Such studies would not only relate to storage but also to the transmission of information from repository to repository and from repository to user. C. COMMUNICATION, INCLUDING TRANSMISSION One prominent student of human behavior has stated that individuals are overcoming their "print fixation syndrome" and will relatively quickly accept the use of new forms such as a console display system at the desk or in place of a card catalog if the information sought turns out to be readily available. Undoubt- edly methods of facsimile transmission will come into use as a means of linking regional and local libraries with each other and to national resources as well. The NLM should keep informed on research already accomplished on human factors that may apply to systems development in the biomedical field and basic research on the learning process. It should support projects that relate such basic principles to the situation unfolding in the practical development of bio- science information complexes and encourage and support such studies from the standpoint of the unique requirements of the medical scientist and practitioner. An area of importance in the solution of the total communications problem is applied research on the actual mechanisms for transmission of data to the user, whether he is nearby or remote from the source of the information. Such ter- minal mechanisms should clearly relate, when appropriate, to various automatic data storage and retrieval systems. An additional area of priority of special interest to NLM for attention Is that of research in the history of life sciences with special reference to the history of medicine as it relates to social, cultural, and scientific advancements. IV. Publications and Translations Within the last 2 years the Public Health Service has supported two major efforts devoted to communications in the health and medical sciences. In No- vember 1962, the Surgeon General invited a number of special consultants to meet with him and the members of the Public Health Service for a working con- ference on health communications. In October 1963, the National Academy of Sciences-National Research Council was asked by the Director of the National Institutes of Health for a "broad examination and assessment of the problem of communication among working scientists in the biomedical area." Both of these endeavors resulted in a number of recommendations, some of which called for in- creased support of activities such as those presently conducted by the National Library of Medicine. The National Library of Medicine has since 1961 been providing support, by dollars and special foreign currencies, for scientific publications to improve bio- medical communications, both national and international. Because other ele- ments of the Public Health Service provide support for primary publications, the library has chosen to support secondary publications, that is indexes, ab- stracts, bibliographies, and critical reviews. These are tools which enable a scientist or medical practitioner either to locate information or to ascertain that such information does not exist. Moreover, the library has sponsored the trans- lation, publication, and distribution of Soviet, Polish, Japanese, and Serbo- Croatian literature of interest to the U.S. scientific and medical community. SECONDARY PUBLICATIONS One of the recommendations of the NAS-NRC study was that NLM with ap- propriate consultation "be encouraged to seek out gaps and deficiencies in the ab- stracting coverage of biomedical literature and to assume leadership in seeking to close these gaps to clear any deficiencies." The Surgeon General's Conference on Health Communication also recommended support for abstracts and indexes and a greater number of critical reviews of high quality. There have been a number of such recommendations; but clear-cut documentation is needed to de- velop the guidelines necessary to determine what priorities the library with its limited funds should place on support of these various forms of publication. Therefore, the library wishes to examine critically the coverage and effective- ness of present biomedical abstracting and indexing in order to decide whether0067051_000024.txt

Page  24 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1075 needs will be served by strengthening existing abstracting and indexing services or whether new services need to be created for specialized interest groups. More- over, professional societies and abstracting and indexing services should be encouraged to develop standards and compatible classification systems for ab- stracting and indexing. With regard to critical reviews, it is again necessary to pinpoint existing difficulties. The inadequacy does not appear to be the number but rather the nature of the reviews. More highly evaluative reviews are needed instead of noncritical summaries. The library will have provided approximately $64,000 for support of bibliog- raphies in fiscal year 1964 and approximately $208,000 for better and expanded abstract coverage of Japanese and Soviet literature. This type of support will be continued with some substantive program modification for fiscal year 1965 but no moneys have been available to support the analytical studies needed for policy guidance on future programing. Therefore, additional funds are needed for: (a) studies to analyze abstracting and indexing programs in terms of the needs of the U.S. scientific and medical community; (b) specialized ad hoc working groups of scientists, medical practitioners, and editors to identify specific subject matter coverage for critical reviews and bibliographies. TRANSLATION ACTIVITIES Both the Surgeon General's conference and the NAS-NRC study recognized the value of translation activities and recommended extension of this to other foreign language material unfamiliar to U.S. scientists. A large proportion of the NLM funds has been devoted to translation activities; that is, providing U.S. scientists with better access to the foreign literature. The library has changed from support of cover-to-cover translation of Soviet jounrals to a highly selective screening process by which some 32 journals are examined and the best articles are selected for publication and distribution to the members (12,000) of the Federation of American Societies for Experimental Biology. Emphasis in the translation program should not be limited to the Soviet or Soviet bloc scientific journals. The library is evaluating these programs, their usefulness to the U.S. biomedical community and recom- mends expansion of the subject matter and language coverage to include Japanese, French, German, and Spanish. Furthermore, a shift from translation activities to the production of specialized articles, critical reviews, and bibliographies of foreign literature is also necessary. In the foreign science program, the dollar funds will be supplemented by the foreign currencies. In 1963, the Surgeon General of the Public Health Service delegated the National Library of Medicine authorities "(to act) as the principal resource within the Public Health Service for the improvement of the inter- national exchange of published biomedical information through extramural sup- port for the translation of foreign journals, monographs, critical reviews, an- nouncement services, handbooks, data compendia, abstracts, indexes, etc., and the distribution of these translated materials to the American biomedical com- munity." Special foreign currencies are presently available to the library in Israel, Poland, Yugoslavia, and India. INTERNATIONAL SCIENCE COMMUNICATION ACTIVITIES The Surgeon General's Conference on Health Communications recommended that there be more effective international communication of research results by abstracts, indexes, and critical reviews. The NLM wishes to expand, selectively, its international activities. The goal of the proposed international programs would be to encourage international cooperation through many different chan- nels, but with the basic objective of increasing scientist-to-scientist cooperation. Accordingly, international governmental channels such as UNESCO and WHO will be used, as well as the nongovernmental international unions devoted to biological, physiological, and biomedical sciences. Those programs concerned with United States-Japanese biomedical communication will be consistent with the objectives of the United States-Japanese cooperative science programs initiated by talks between President Kennedy and Prime Minister Ikeda. This could include joint preparation by a U.S. scientist and his foreign colleague of critical reviews and bibliographies which will be of direct interest to the U.S. scientific and medical community.0067051_000025.txt

Page  25 1076 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATION* V. Additional Unmet Nekiis The activities just described in I through IV will bring an effective force to bear on many problems of medical libraries since they will permit programing for the support of scientific publications, training, research in library-related biomedical communications systems and library resources. Our authorities at present, however, do not include grant programs for construction, and space is one of the more urgent problems of the medical libraries. The space problem is not unrelated to the need for the development of major regional libraries across the country CONSTRUCTION The sine qua non of any Federal effort to assist medical libraries is a pro- gram for help in construction of new library buildings, the renovation and re- habilitation of existing structure, and the provision of equipment necessary to operate these facilities. Several authoritative studies have convincingly dem- onstrated the desperate nationwide needs for new, expanded, and rehabilitated physical facilities for biomedical libraries, particularly those in schools of medi- cine and other health-related professions. The existing professional school needs for new construction and .rehabilitation are augmented by the plans for major expansion in the number of such schools in the country. Each of these new schools will require a modern library. Because of the central role played by the library in the modern medical center for research, education, and clinical activity, it is believed that high priority should be assigned to aiding programs of providing adequate physical facilities to these institutions. In addition to the schools of the health professions, other public and nonprofit private institutions for research and patient care are in dire need of assistance to convert the physical plants of their biomedical libraries from their present inadequate state so they can make their necessary contribution to the sub- stantive work of the users. The needs of the biomedical libraries of the Nation are not solely the result of the neglect which they have suffered in the past, but are magnified by the role which they will be required to fulfill in the future. The library will assume increased importance as a center for education, not only in the traditional sense of providing study space, but with new instruc- tional media available, such as programed learning material, audio and video tapes, films and slides, it assumes a much expanded function in this regard. This function imposes the further necessity for space more specialized than has been needed in the past. Most biomedical libraries as they exist today are in- capable of assuming effective roles because of the limitation placed on them by Inadequate and antiquated physical plants. More than 50 percent of the medical school libraries were built over 30 years ago. Of the 87 existing medical schools, it is estimated there are 72 with measur- able deficiencies in collections and housing. There are also schools of dentistry. public health, osteopathy, and nursing to consider and these still are only one segment of the medical libraries that need attention, although, to be sure, those of very high priority. In January 1963, the Association of American Medical Colleges indicated that 75 established medical schools were in need of construc- tion for new or expanded facilities which would cost approximately $93,070,000 and the 11 schools in the development stage at that time needed nearly $12 million. A necessary goal of the NLM is to develop a program designed to meet the critical needs of our Nation's medical libraries. We believe the basic elements of such a program are contained in this prospectus. We are faced with a major challenge and believe we are prepared to meet it now. Where we are lacking is in the necessary fiscal resources to implement such a program. Extbamural Program Summary An extramural program plan has been presented which identifies major areas for immediate and longer range attention and support. The narrative describes the immediate program plans in some detail; long-range plans and additional unmet needs are indicated but have not been expanded upon at this time. Utilizing existing authorities, the program has been structured initially on a four-point program. The funds necessary to implement the program in the first year are as follows:0067051_000026.txt

Page  26 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1077 Extramural program plan I. Training and fellowships________________________________ $600, 000 II. Regional library complexes and resources__________________ 500, 000 III. Research and development_______________________________1, 000, 000 IV. Publications and translations_____________________________ 150, 000 Program direction, review, and approval of grants and admin- istration of grants and contracts (including 11 positions)____ 250, 000 Total_____________________________________________2, 500, 000