1968 U.S. Senate Appropriations Committee Budget Testimony, 90th Congress 1st Session, April 18, 1967
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Page  2 National Library of Medicine STATEMENT OF DR. MARTIN M. CTJMMINGS, DIRECTOR; ACCOM- PANIED BY SCOTT ADAMS, DEPUTY DIRECTOR; DR. MARJORIE P. WILSON, ASSOCIATE DIRECTOR, EXTRAMURAL PROGRAMS; AND JAMES D. ISBISTER, EXECUTIVE OFFICER, NATIONAL LIBRARY OF MEDICINE; DR. WILLIAM H. STEWART, SURGEON GENERAL; G. R. CLAGUE, ACTING CHIEF FINANCE OFFICER, PUBLIC HEALTH SERVICE; AND JAMES B. CARDWELL, DEPUTY ASSIST- ANT SECRETARY, BUDGET Appropriation Estimate National Library op Medicine To carry out section 301 of the Act and for expenses, not otherwise provided for, necessary to carry out the National Library of Medicine Act (42 U.S.C. 275), and the Medical Library Assistance Act of 1965 (79 Stat. 1059), [$20,192,0001 $21,162,000, of which C$13,800,0001 $6,500,000 shall remain available until June 30, [196811^69. Amounts available for obligation (new obligational authority basis) 1967 1968 $20,192,000 62,000 $21,162,000 Comparative transfer from "Office of the Surgeon General, salaries and Total..............-. 20,254,000 21,162,000 Obligations by activity 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Grants: $1,000,0001 1,000,000 120,000 7,500,000 2,935,000 200,000 $1,400,000 1,000,000 100,000 5,000,000 2,800,000 1,500,000 ---- +$400,000 Training: -20,000 -2,500TDOO -135,000 +1,300,000 12,755,000 11,800,000 -955,000 Direct operations: 357 5,674,000 1,045,000 715,000 7,861,400 700,000 800,600 399 48 +2,187,400 -345,000 Review and approval of grants and 40 +85,600 397 7,434,000 9,362,000 447 +1, yJ8,000 397 20,189,000 65,000 21,162,000 447 +973,000 -65,000 Total, obligations and balance...... 397 20,254,000 21,162,000 447 +908,000 15890146260_000003.txt

Page  3 1590 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Obligations by object Total number of permanent positions.-...................... Full-time equivalent of all other positions......------.....- Average number of all employees...............--......---- Personnel compensation: Permanent positions____________________.........— Positions other than permanent___________...........- Other personnel compensation................--------- Total personnel compensation____.....------------- Personnel benefits............-----...............-------- Travel and transportation of persons..........----.....---- Transportation of things...........................-------- Rent, communications, and utilities_______.....---------- Printing and reproduction___________________......----- Other services......-----...............--.....-—.....---- Project contracts..............----------------------- Services of other agencies.....----------------....... Payment to "National Institutes of Health management fund".....................................----------- Supplies and materials________________________________ Equipment...................-----..............-------- Grants, subsidies, and contributions___......----......--- Total obligations by object......------------......... 1967 estimate 397 6 355 $2,841,700 54,000 10,600 2,906,200 224,000 116,600 7,600 179,060 272,360 80,700 2,677,800 134,000 668,200 109,800 368,800 7,788,828 15,622,828 1968 estimate 447 12 397 $3,355,300 123,000 30,600 3,508,800 266,400 186,200 12,600 277,850 327,960 163,900 3,305,200 138,000 743,200 155,800 276,200 19,500,000 28,862,000 Increase or decrease +60 +6- +42 +$513,600- +69,000 +20,000 +602,600 +42,400 +70,600 +5,000 +98,800 +65,600 +83,200 +627,400 +4,000 +86,000 +46,000 -92,600 +11,711,172 +13,339,172 Summary of olionges (New Obligational Authority Basis) 1967 enacted appropriation------------------------------------$20,192, 0001 Comparative transfer, from "Office of the Surgeon General, Salaries and Expenses"_____________________________________________ 62,00O Unobligated balance, reserve__________________________________ —65,000 1967 total estimated obligations_____________________________ 20,189,00O 1968 estimated obligations________________________________ 21,162,000 Total change___________________________________________ 973,000 Base Changes from base Positions Amount Positions Amount Increases: A. Built-in: 1. Annualization of 22 positions new in 1967........................... $64,800- B. Program: 1. Research and development_____ $1,000,000 200,000 617,192 93,808 154,000 400,000 1,300,000 259,200 80,900 974,900 138,000 2. Regional medical libraries______ 3. Medlars indexing and searching.. 42 8 1 11 1 8 1 1 8 20 5. New computer system installa- 6. Executive direction and admin-istration_________............ 7. Program analysis,............... 62,800 85,600-900,000- 8. Review and approval of grants arid contracts . 40 715,000 9. Toxicology information exchange. Total program increases____ 50 4,256,200--241,000--30,000 -345,000 -12,200 -135,000 -2,500,000 -20,000 Decreases: A. Nonrecurring items of cost: ~ B. Pay above stated annual rate in 1967___ C. Publications and library support....... 2,935,000 7,600,000 120,000 D. Construction grants.................... E. Special scientific projects______........ -3,283,200 +973,000 ===== ^=== +60 0146260_000004.txt

Page  4 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1591 EXPLANATION OF CHANGES Research and development grants An increase of $100,594 will bring the total for this program up to $1,400,000 for 1968 which will provide for approximately twenty-eight grants to improve the distribution of documents, bibliographic materials, and information to health scientists and practitioners. Construction grants An increase of $12,500,000, composed of $7,500,000 carryover of 1967 funds plus $5,000,000 requested as new obligational authority in 1968, will support approxi- mately thirteen construction projects. Regional medical libraries An increase of $1,300,000 for a total of $1,500,000 will support seven institu- tions in 1968. Publications and library support An increase of $65,000 for a total of $300,000 in 1968 for support of publica- tions and a decrease of $2,176,002 leaving a total of $2,500,000 for library re- sources will result in a net decrease of $2,111,002. The reduced amount will sup- port 290 awards. Training A decrease of $86,496 in special scientific projects and an increase of $8,076 for support of training will result in a net decrease of $78,420. The reduced amount will support two special scientific projects and twenty training grants. MEDLARS indexing and searching An increase of $259,200 and eleven positions will enable the Library to increase intramural indexing and searching and to contract for the indexing of biomedical literature to reduce the backlog. MeSH development An increase of $80,900 and one position is necessary to improve the quality, scope, and level of sophistication of Medical Subject Headings, giving particular attention to biochemical mechanisms and biomedical engineering. New computer system An increase of $974,900 and eight positions is required to complete planning for a second-generation MEDLARS, provide systems analysis staff for expanding programs of increasing complexity, and conduct a program of intramural research. Executive direction and administration An increase of $138,000 and one position will permit the Library to establish a contract management office and to strengthen other administrative manage- ment operations. Program analysis An increase of $52,800 and one position is necessary for intramural analysis and to hire consultants for program evaluation. Review and approval of grants and contracts An increase of $85,600 and eight positions will provide the scientific expertise required to conduct the diverse program of medical library assistance and will provide a grants management and processing staff. Toxicology information exchange (TIB) An increase of $900,000 and twenty positions is required to begin planning of this new program by data gathering and analysis of toxicological information sources and user needs, and to hire top-level management staff, analysts, an program specialists.0146260_000005.txt

Page  5 1592 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Direct operations and grants 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Personnel compensation and benefits..... Other expenses............................ 397 $3,130,200 12,392,628 447 $3, 775,200 25,086,800 + 50 +$646,000 +12,694,172 Total............................. 397 15,622,828 447 28,862,000 +50 +13,339,172 Summary of program 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Medical library assistance, grants and contracts: Research and development: Grants............................ $1,299,406 800,000 $1,400,000 200,000 +$100,694 Contracts......................... —600,000 Total, research and develop- 2,099,406 1,600,000 -499,406 Training: Grants............................ 1,191,924 186,496 1,200,060 100,000 +8,076 -86,496 Special scientific projects......... Total, training.................. 1,378,420 1,300,000 12,500,000 -78,420 +12,500,008 Construction grants......._____..... Publications and library support: Publications: Grants.............._......... 235,000 545,000 300,000 600,000 +65,000 -46,000 Contracts.................... Total, publications__...... 780,000 4,676,002 800,080 2,600,000 +20,000 -2,176,002 Library resources: Grants........ Total, publications and library support....................... 6,456,002 200,000 9,133,828 = 3,300,000 1,500,000 20,200,000 = -2,166,002 +1,300,000 +11,066,172 Regional medical libraries: Grants___ Subtotal, extramural grants and contracts.................. === Direct operations: Library operations_____........... 367 7,019,000 -1,345,000 399 8; 661,400 -700,000 +42 +1,542,400 +645,000 Less contracts, included above........ Intramural library operations....... 357 40 397~ 5, 674,000 716,000 15,522,828 399 48 7,861,400 800,600 +42 +8 +2,187,400 +85,600 Review and approval of grants and contracts___.....______....... Total, National Library of Medicine. 447 28,862,000 +60 +13,339,172 Introduction The biomedical knowledge of the world is recorded in a wide variety of forms and languages at an ever increasing rate of volume and complexity. The insti- tutions and mechanisms- which exist to collect, organize, and disseminate bio- medical information are outmoded and inadequate. As a result the potential value of existing biomedical knowledge is not fully realized in health research, educa- tion, and practice. ^ The goals of the National Library of Medicine programs are to assist the advancement of medical and related sciences through the conduct and support of programs which improve the flow of biomedical information from the point of0146260_000006.txt

Page  6 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1593 generation to the ultimate user for the purposes of research, education, and medi- cal practice and thus contribute to bringing the latest advances in health care ultimately to the patient. NLM assists in strengthening biomedical libraries and related institutions, exploiting current interlibrary relationships, improving information handling techniques, and enhancing the role of libraries as learning resources. The 1968 budget request includes funds for awards in all categories of support authorized under the Medical Library Assistance Act of 1965 to assist in the development and support of the Nation's biomedical information resources. In- creases are requested for research in medical library science and information systems and techniques, and development of regional medical libraries. In order to strengthen the Library's ability to meet increased demands for service, the budget contains increases to plan and develop a toxicology informa- tion exchange; conduct systems design and provide partial staffing of a new computer system; accelerate the development of NLM's medical literature anal- ysis and retrieval capability to keep pace with the growing body of literature and demand for computer-based bibliographic services; improve medical subject headings; strengthen executive direction and administration; conduct a pro- gram analysis activity; and increase the staff to administer the expanding extra- mural program. Medical library assistance, grants 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount $7,788,828 $19,500,000 +$11,711,172 The 89th Congress recognized that the unprecedented expansion of knowledge in the health sciences within the past two decades has caused massive growth in the quantity, and major changes in the nature of, biomedical information. In enacting the Medical Library Assistance Act of 1965, the Congress noted that there has not been a corresponding growth in the facilities and techniques neces- sary to coordinate and disseminate the ever increasing volume of knowledge and information which has been developed in the health science field, and, that much of the value of this ever-increasing volume of knowledge will be lost unless the proper measures are taken in the immediate future to develop facilities and tech- niques necessary to collect, preserve, store, process, retrieve and facilitate the dissemination and utilization of such knowledge and information. The Medical Library Assistance Act provides for a comprehensive program of support through: (1) grants and contracts for research in the field of medical library science and related activities and development of new techniques, systems, and equipment for processing, storing, retrieving and distributing information in the sciences related to health; (2) grants for training of medical librarians and other information specialists in the health sciences ; (3) grants for special scientific projects conducted under special fellowships awarded to physicians, scientists, and other practitioners in the sciences related to health, which will facilitate the distribution and utilization of knowledge and information relating to scientific, social, and cultural advances in sciences related to health; (4) grants for construction of new, and the renovation, expansion, or rehabili- tation of existing medical library facilities; (5) grants for improving and expanding the basic resources of medical libraries and related facilities; (6) grants and contracts for financial support of biomedical scientific publications; (7) and, grants for development of a national system of regional medical li- braries each of which would have facilities of sufficient depth and scope to supple- ment the services of other medical libraries within the region served by it.0146260_000007.txt

Page  7 1594 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Research and development 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Grants.....____________.............. $1,299,406 $1,400,000 +$100,594 Research grants 1967 estimate 1968 estimate Increase or decrease Number of awards Amount Number of awards Amount Number of awards Amount Noncompeting continuations....... 17 19 $455,406 844,000 17 11 $740,000 660,000 +$284,594 -8 -184,000 Total _____________ 36 1,299,406 28 1,400,000 -8 +100,694 The Library requests a net increase of $100,594 to support research and development projects in 1968. The total amount of new obligational authority requested for this sub-activity is $1,400,000. Obligations in 1967 consist of $1,000,- 000 in new obligational authority plus $299,406 brought forward from 1966. The support of research and development in medical library science and re- lated fields is based on the premise that the information resources of the Nation's biomedical libraries must be made available to its health practitioners, scientists, and students in the forms, volume, and with the speed required to meet users' needs for relevance, specificity, and timelines®. Evaluation of research and development projects must consider the time available to the physician and other users to find, digest, and evaluate medical information; the unique communication requirements of the medical community; and the potential benefit to the health of the people of timely, pertinent, and Teliable information. Research and development approaches to solutions of bio- medical information problems involve three basic steps: 1) identification of user motivation and requirements through exploration of the preferences for different methods of information assimilation and identification of information gathering methods; 2) technical development of terminology, nomenclature, classification, and linguistics for the solution of traditional problems in indexing, abstracting, translation, and search strategy, and development of new media; and, 3) synthesis of the findings of behavioral and technical research. The NLM is currently supporting research projects in each of the three broad areas outlined above. Program plans for 1967 emphasize the support of projects defined above as critical to the whole process; namely, the behavioral aspects of the information gathering process. During 1968, the Library will continue to support research in these three major areas but will emphasize studies for improving the techniques of information acquisition, organization, processing, preservation, and retrieval and the integration of behavioral and technological research efforts into effective communication systems. The NLM also awards grants for projects in the history of the life sciences with special reference to the history of medicine. By preserving and illuminating the historical record, these projects provide the potential for a better under- standing and appreciation of contemporary health activities. Travning 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Total grants_________________________ $1,378,420 $1,300,000 -$78,420 0146260_000008.txt

Page  8 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1595 This sub-activity includes grants for training and special scientific projects. The net decrease of $78,420 for 1968 consists of an increase of $8,076 in train- ing offset by a decrease of $86,496 for special scientific projects. A. Training 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount $1,191,924 $1,200,000 +$8,076 1967 estimate 1968 estimate Increase or decrease Number of awards Amount Number of awards Amount Number of awards Amount Non-competing continuations..... 9 11 $526,924 665,000 20 $1,200,000 +11 -11 +$673,076 -665,000 Total . ... 20 1,191,924 20 1,200,000 +8,076 The Library requests an increase of $8,076 in 1968 to award training grants. This will result in a total obligational authority of $1,200,000 in 1968 composed of $200,000 brought forward from 1967 plus $1,000,000 in new obligational au- thority (the amount of yearly authorization in the Medical Library Assistance Act). The 1967 base of $1,191,924 is composed of $191,924 brought forward from 1966 plus $1,000,000 in new obligational authority. $200,000 must be carried for- ward from 1967 to 1968 in order to meet non-competing continuation commit- ments. The success of a national health science information system is dependent upon the availability of a national manpower resource skilled in information com- munication techniques. In the United States and Canada, of the 2.188 graduates from the 36 accredited library schools in 1963, 1,839 were identifiable as known placements. Of these, 24 were placed in medical libraries and 13 in hospital libraries. It is not known how many of these had specific training in medical librarianship. Serious as the quantitative problems are, simply adding more schools which offer a course in medical bibliography will not solve the infinitely more far- reaching problems. Training programs are needed which go beyond the basic traditional training in library science and provide the student with an educa- tional experience that combines theoretical depth with research or practical experience all directly related to the problems of medical science. Rapid retrieval of drug information, continuing education of the physician, provision of regional medical services, library backup for specialized information centers such as those in Parkinsonism, brain research, diabetes, and cardiovascular disease are the types of services needed. With the growing concept of the learning resource center in the medical complex, the medical library will no longer be limited to books and journals but will be responsible for the newer instructional media. B. Special scientific projects 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount $186,496 ______| $100,000 -$86,496 The Library requests $100,000 to support approximately 6 Special Scientific Projects in 1968, Obligations in 1967 consist of $120,000 in new obligational authority plus $66,496 brought forward from 1966, to bring total obligations in 1967 to $186,496,0146260_000009.txt

Page  9 1596 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Special scientific projects are awarded on behalf of individuals to compUe existing data and to make original contributions to the literature on the scien tific, social, and cultural advances in the health sciences. rontribu- In 1967, particular attention will be directed toward studies*°n ^e wntnou tions of contemporary health practitioners and the drug i^o™**1^^.Ximeirts the United States. In 1968, programs in one or two selected m^^e?J?KS5 will be designed to foster an awareness in the medical community of the sociaj and cultural aspects of the health sciences. Construction Grants. 1967 estimate Posi- tions Amount 1968 estimate Posi- tions Amount $12,500,000 Increase or decrease Posi- tions Amount +$12,500,000' The $5,000,000 requested for construction in 1968, when combined with the $7,500,000 carried over from 1967 will make a total of $12,500,000 available for obligation in 1968. This grant support will provide up to 75% of the costs of constructing, renovating, expanding or remodeling biomedical library facilities in medical schools, and other health profession or service institutions. The Association of American Medical Colleges has reported that a survey conducted in 1964 showed that its member institutions required more than $87,000,000 for medical library construction and renovation. This sum represents about $65,000,000 in Federal funds when the 75 percent matching rate as allowed in the Medical Library Assistance Act of 1965 is applied. The survey did not take into account the needs of free-standing health science libraries and those in other health professions educational institutions which are estimated to re- quire an additional $10,000,000 in Federal funds. A 1964 study by the Association of American Medical Colleges provided quali- tative data for the establishment, operation, support and functions of libraries in medical schools. The Library contracted with the same organization in 1966 to develop criteria and planning guidance for the construction of medical libraries. The new study devotes special attention to the role of the medical library as a learning resource, considering facilities for use and dissemination of audio-visual and other non-print material. The information from the 1966 study supplemented by the criteria reported in the 1964 study provides guidelines for effective implementation of the medical library construction grant program. To date, eleven construction grant applications have been submitted and are under review. Funds carried over from 1967 plus the 1968 appropriation will fund approximately thirteen projects in 1968. These projects will include the cost of original construction or the renovation, expansion or remodeling of biomedical library facilities in non-profit health institutions. In reviewing appli- cations for construction grants, consideration will be given to the relative effectiveness of the proposed facilities in meeting demonstrated needs for addi- tional or improved medical library services. Publications and library support 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount $4,911,002 $2,800,000 -$2,111,002 This subactivity includes grants for publications support and for library re- sources. A net decrease of $2,111,002 for 1968 results from a requested increase of $65,000 for publication support, offset by a decrease in the library resource grant program of $2,176,002. These programs are discussed separately below:0146260_000010.txt

Page  10 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1597 A. Publications support 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Grants_________________ ... _. $235,000 $300,000 +$65,000 The Library provides financial assistance for non-profit biomedical publications to make available to the health related professions information of significance to the national health effort. To facilitate the utilization and availability of health science information, support must be provided for the preparation of abstracts, bibliographies, translations, handbooks, indexes, and secondary biomedical pub- lications. In addition, primary or secondary publications in the field of medical librarianship and related areas of information science are supported. Assistance is provided to periodical publications in need of temporary support for the expan- sion or improvement of services to the readers. During 1967, the Library will continue to identify information gaps in certain subject matter areas and provide special assistance such as abstracting projects to meet the identified need. Also, an evaluation of the utility and effectiveness of those publications being supported currently will continue. In 1968, a special effort will be directed toward studies of the availability, dissemination, and usefulness of existing and planned translation services. By this effort, the Library seeks to improve its contribution to international communication through the improved and increased exchange of recorded sci- entific information. For these purposes, the Library requests an increase of $65,000 in 1968. B. Library resources 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount $4, 676,002 $2,500,000 —$2,176,002 A total of $2,500,000 is requested for this program in 1968. This represents a decrease from 1967 of $2,176,002 in obligational authority. Obligations in 1967 consist of $2,700,000 in new obligational authority plus $1,976,002 brought for- ward from 1966. Grants will be made to improve and expand medical library resources which may be used to: strengthen colections through the purchase of books, journals, and other informational resources; improve access to the holdings of libraries by providing support for cataloging, binding, and other processing services; introduce new techniques in health service librarianship; and acquire photo- duplication devices, film projectors, microfilm readers, and other needed equipment. While the specific amount of each resource grant is determined by a formula, the basis for approval will be the merit of the plan set forth for the provision of services utilizing the resources to be obtained with the grant. Before awarding such grants the scope of services provided and planned by the medical library will be examined and numbers of users who will require services will be con- sidered. The services and resources of the applicant, both existing and proposed, will be reviewed in the context of the geographic area served by the library along with those of other libraries in the area. In this way, planning for total coverage by library services will be stimulated at all interrelating levels, viable libraries will be identified and strengthened, and library service can be generated for user groups not adequately covered previously. A guiding principle of the resource grant program is to provide a means for optimizing materials and techniques which are available. A further guiding0146260_000011.txt

Page  11 1598 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS principle in the planning of this program has been to reach as large a number as possible of libraries capable of providing useful and necessaryservice. The NLM plans to award grants to 200 libraries in 1967. The $2,500,uw re- quested in 1968 will provide grants to an additional 75 libraries. Regional medical libraries 1967 estimate 1968 estimate Increase or decrease, Posi-tions Amount Posi-tions Amount Posi-tions Amount $200,000 $1,500,000 +$1,300,000. The Library requests $1,500,000, an increase of $1,300,000 over the 1967 amount, to support regional medical libraries in 1968. The Medical Library Assistance Act authorizes this program of grants to existing institutions to enable- them to assume responsibilities for providing regional medical library services in support of local medical libraries having limited resources. This program will provide grants to the designated regional libraries for acquisition of library resources, cataloging, binding, and other processing activities; acquisition of equipment to facilitiate the use of library resources; acquisition of mechanisms and employment of personnel to provide rapid transmission of materials and. information between regional libraries and the local libraries which they serve; and necessary construction, renovation, rehabilitation or expansion of facilities to provide regional services. Grantee institutions will be required, as a condition of the grant, to expand and modify their supportive facilities and services and to provide free loan services and photoduplication services to qualified requesters. In addition to the above function, the regional libraries will be expected to give the widest possible dissemination to information concerning their resources and services. Discussions with neighboring areas are also encouraged in order to insure complete coverage ultimately of all users in a national network of' biomedical libraries. In 1967 one regional medical library will be supported. Additional funds in 1968 will provide for six more for a total of seven regional medical libraries. supported in 1968. Direct operations 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount 397 $3,130,200 4,603,800 447 $3,776,200 5,586,800 +50 +$645,000 +983,000 Total............................... 397 7,734,000 447 9,362,000 +50 +1,628,000 Library operations 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Personnel compensation and benefits...... 357 $2,844,000 2,830,000 399 $3,412,300 4,449,100 +42 +$568,300 ■ +1,619,100- Total_________________________ 357 5, 674,000 399 7,861, 400 +42 +2,187,400 ■ 0146260_000012.txt

Page  12 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1599 MEDLARS indexing and searching.—The Library requests an increase of eleven positions and $259,200 to meet indexing and searching goals in 1968. MED- LARS was designed to provide improved bibliographic access to the voluminous biomedical literature for health scientists, practitioners, and students. It was the first application of a computer to the problems of scientific information process- ing in a library. MEDLARS has been outstanding in its success. The Library will have over 600,000 citations to medical articles on magnetic tape by the end of 1967. but this is not adequate. The same reason that brought the need for the MEDLARS system—the explosion in the volume and scope of scientific litera- ture—now requires that the Library expand its efforts to index all significant articles from the biomedical literature for publication and retrieval purposes. The Ad Hoc Panel on Selection of Journals for Index Medicus recommended that 600 periodicals be added to the 2,300 already being indexed. Many top quality journals have increased the number of articles published in each issue as well as the number of issues per year. The Library began a concerted effort in 1965 to improve the quality of computer input, and thereby bibliographic output, by care- ful expert selection of journals to be indexed, by modifying headings to reflect articles content more accurately, and by more intensive review of indexer data sheets to increase the quality and consistency of indexing. Due to inadequate staff, the Library's Index Section is experiencing a backlog of articles to be indexed which is growing at the rate of 2,000 articles per month. By the end of 1967 the total backlog will reach approximately (>0,000 articles. In order to par- tially reduce the backlog the Library will contract for some indexing. The re- quest includes $87,000 to contract for indexing of about 20,000 articles in 1968. The request for positions includes 4 additional indexers, 2 revisers (senior in- dexers), and one clerk-typist to meet the Library's goal of 200,000 articles indexed in 1968. The Library's Search Section, with responsibility for retrieval of information entered into the computer, produces recurring bibliographies, demand researches, and selects certain demand research bibliographies of general interest for wider distribution at very low cost. To meet the Library's 1968 goal of 3,600 demand searches, 20 recurring bibliographies, and 40 recurring demand searches, the request for positions includes 3 additional searchers and one clerk-typist. The Library has established a training program in indexing and search proce- dures to train employees of decentralized MEDLARS search centers. In addi- tion to their regular duties, the new index and search positions will be used to assist in this program. Funds requested will be used for contract indexing, in- creased printing costs for Library publications, library supplies and equipment, travel, and to fund new positions. Medical Subject Headings (MeSH) development.—The Library requests an increase of $80,900 and one position for Medical Subject Headings development. The National Library of Medicine has developed a uniform system of classifica- tion for the medical literature to exploit more fully its MEDLARS computer sys- tem. The Medical Subject Headings list has three basic applications : 1. It is the subject heading authority for indexing in Index Medicus and MEDLARS. 2. It is the subject heading authority for cataloging at the NLM. 3. It is the dictionary or key for the user of Index Medicus and the indi- vidual who requires or demands searches on the MEDLARS computer. MeSH is used not only in this country, but world-wide as a medical thesaurus. The Bibliotheque Nationale has adopted it as the official subject heading author- ity for France. The development and updating of MeSH is carried out by Library staff in consultation with committees of experts and individual authorities in the various fields. The list of Medical Subject Headings must be constantly revised and updated as the volume and scope of the world's biomedical literature expands and as the biomedical sciences encompass a greater variety of academic dis- ciplines. As the disciplines become more sophisticated, their language and termi- nology evolve and change causing terms in the list of Medical Subject Headings to be revised. The Library has a planned program for improving the quality, scope, and level of sophistication of its Medical Subject Headings. During 1966 and 1967, the areas of epidemiology, behavioral science, medical care, and organ0146260_000013.txt

Page  13 1600 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS transplantation were analyzed, and index terms, interdisciplinary vocabularies, and methods for the display of the vocabulary were developed. During 1968par- ticular attention will be given to revising and improving the terms used to describe literature pertaining to biochemical mechanisms and biomedical en- gineering. The position requested will be used to employ an additional medical subject headings specialist Funds will be used to pay for consultative services, contracts for new terminology development and other miscellaneous expenses. New Computer System: Installation and Research.—The Library requests an increase of $974,900 and 8 positions for reprogramming and conversion to a new computer system, initial installation of new computer equipment, and systems development and research. The Library will begin installation of a new computer system to meet future data processing and information systems requirements for: (1) an increase in the level of MEDLARS bibliographic services provided including demand searches and recurring bibliographies; (2) an on-line input system to MEDLARS permitting the indexer and the searcher to communicate directly with the com- puter; (3) an automated acquisitions and cataloging system; (4) a graphic image storage and retrieval system closely linked to the MEDLARS computer search capability; (5) a drug literature program with chemical search capabil- ities added to MEDLARS; (6) a Toxicology Information Exchange; (7) an intramural research and development program in information retrieval and scientific documentation. The computer system will incorporate: (1) processing capacity many times that of present hardware; (2) mass random access memory measured in billions of characters; (3) on-line consoles for direct access into the computer files; and (4) data communications capability for electronic linkage to other centers. The request contains an increase of six positions and $49,100 to provide per- sonnel to monitor the development of the new systems. Increased costs associated with developing the new system and operating the old system amount to $253,200 and include $105,800 for equipment rental, $30,000 for equipment maintenance, $76,900 for equipment purchases and $40,500 for miscellaneous items. Contracts for conversion to the new system and reprogramming in 1968 will require an increase of $650,600. The installation of the new computer system and the general increase in the Library's intramural research and development activities in 1968 will place a heavy burden on the present systems analysis staff of the Library- As the corner- stone of the Nation's biomedical information system, the Library must spear- head efforts for the development and testing of new techniques for collection, organization, processing, and dissemination of all forms of biomedical informa- tion. Library staff will conduct research projects in graphic image storage and retrieval and other forms of scientific documentation. An increase of two posi- tions and $22,000 for systems analysis and research is requested. Executive Direction and Administration.—An increase of one position and $138,000 is requested to strengthen the management of the Library to meet in- creased responsibilities and workload resulting from program growth. Administrative management services for the Library are provided centrally. Due to its organization status, the Library is required to provide a broader range of such services in greater depth than would be normally the case for an organization of its size. With the greatly increased program responsibilities and enlarged staff and budget of the Library, resulting principally from the enact- ment of the Medical Library Assistance Act of 1965, and the initiation of a Toxi- cology Information Exchange, prudence dictates that the administrative manage- ment offices be bolstered. • ^PItS1* r -KUdg^ haS gf°Wn fr0m $9-685'°00 in 1966 to more than $21,000,000 in 1968. The Library's contract program has increased sharnlv frnm nhmir $1,000,000 in 1966 to over $3,000,000 il 1968. The ne^siSon^U be "sed ?o contract management. The funds will be used to support the position and other administrative expenses including office equipment, ^^StSZ^^t to the NIH Management Fund for increased services ^uuibeiuem Program Analysis.--The most pressing need in theOffice of the Director NLM is to enhance the capability for program planning and analysis. The Library has0146260_000014.txt

Page  14 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1601 before it increasingly important responsibilities for the conceptualization of new programs in the area of biomedical communications, for the evaluation of exist- ing programs, and for the provision of standards for the direction of both current and projected programs. As the principal focus for such activities in the Public Health Service, it is imperative that the Library expand its program analysis and evaluation activities. Consultants will be used to a great extent in the evaluation of the NLM program and in the development of plans and objectives. The program analysis office will maintain statistics and other information pertaining to biomedical libraries, health communication and other subjects relevant to NLM program planning. An increase of one position and $52,800 is requested for program analysis and evalu- ation in 1968. Toxicology Information Exchange.—The Library requests an increase of 20 positions and $900,000 for planning and development of a Toxicology Information Exchange. The President's Science Advisory Committee (PSAC) in its report, "Handling of Toxicological Information," drew attention to the urgent need for a better co- ordinated and more comprehensive computer-based file of toxicology information than is currently available. In response to a delegation of responsibility from the President to the Secretary of Health, Education, and Welfare, and subsequently to the Director of the National Library of Medicine, the Library will plan for the development of an action-oriented program through the formation of an organiza- tional unit to be known as the Toxicology Information Exchange (TIE) which, when operational, will: 1. Provide leadership and technical and financial support in the continuing development and operation of a comprehensive system of information on the interaction of chemicals and biological systems (toxicology). 2. Identify, classify, and maintain current description of all toxicology in- formation users and all significant centers and services which accumulate and analyze toxicology information. 3. Propose compatible systems standards and guidelines within Government for storage and retrieval of toxicology information including common vocabulary systems and compatible computer programming, and promote their adoption by the non-Government sector. 4. Respond to incoming requests for stored information, directly or by re- ferral, and provide or arrange repackaging of stored information where signi- ficantly large user-groups are identified. 5. Support preparation of comprehensive chemical information files. Automa- tion techniques will be used when advantages can be gained. 6. Conduct and support research and investigations in those aspects of the processing and communication of toxicology information essential for the development and operation of a user-oriented information system. 7. Provide a data base for the study of biological effects of chemicals which have a meaning to life systems. In 1968 the Library will convene an advisory committee on toxicological in- formation, composed of experts in the various fields of toxicology, in order to provide ad hoc consultations for program development. Two studies, a survey of toxicological information sources and a study of user needs and practices, will be performed on contract. These data gathering and analysis activities are funda- mental to the program and will form the basis for planning and other actions. In addition, work will begin on a bibliography of reviews in toxicology. Positions will be used to recruit the top-level management staff of the program along with high-level analysts and program specialists to work on system design and analysis. Funds requested include $227,000 to fund the 20 positions, $500,000 for project contracts, $20,000 for consultative services, $30,000 for travel, $20,000 for equipment, $10,000 for literature, $20,000 for rental of office space, $10,000 for supplies and $63,000 for other expenses. An overall program reduction of $21S.400 in the Library Operations base is included in the 196S budget. This is comprised of decreases for non-recurring costs of $283,200 partially offset by $64,800 for annualization of 22 position new in 1967. 77-452—67—pt. 2----30146260_000015.txt

Page  15 1602 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Research and support contracts 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount $1,345,000 $700,000 Total___________________......... 1,345,000 === 700,000 200,000 500,000 ===== -645,000 ____ . a------, —■ 800,000 545,000 -600,000 Publications support contracts............ —45,000 Total............................... 1,345,000 700,000 , -646,000 The Medical Library Assistance Act authorizes the Library to use the contract in addition to the grant mechanism for two categories of support—research and publications support In 1968 the grant mechanism will be used to a greater extent resulting in a net decrease for this activity in 1968. The narrative justi- fication for these funds is found under research and development grants and publications and library support grants. Review and approval of grants and contracts 1967 estimate 1968 estimate Increase or decrease Posi-tions Amount Posi-tions Amount Posi-tions Amount Personnel compensation and benefits____ 40 $286,200 428,800 48 $362,900 437,700 +8 +$76,700 +8,900 Total............____.............. 40 715,000 48 800,600 +8 +85,600 The Library must provide initial review for the major portion of the applica- tions for grants under the Medical Library Assistance Act. The NLM staff will service three advisory committees: Manpower and Training Committee, Facilities and Resources Committee, and National Medical Libraries Assistance Advisory Board. Five of the eight positions requested will be used to provide the scientific expertise required to conduct the diverse program of medical library assistance that runs from research and development to construction grants. Three positions will be used for the grants management and processing staff. The growth in the size of the extramural program and in the number of applica- tions and awards to be processed, requires a considerable increase to handle the increased workload and exercise financial and administrative oversight of the awards made. Positions other than permanent are included for the standing com- mittees as well as part-time and intermittent clerical assistants required during periods of peak workload. This estimate assumes appointments to Committees through Civil Service procedures rather than using a contract mechanism.0146260_000016.txt

Page  16 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1603 New positions requested, fiscal year 1968 Grade Annual salary Library operations: Associate Director, toxicology information. Scientist (2)............................... Public health program specialist........... Medical officer............................ Systems analyst........................... Information scientist...................... Medical literature analyst (2).............. Systems analyst (3)........................ Scientist-------.........................-. Administrative staff assistant.............. Supervisory prbgramer.................... Contracts officer........................... Public health program specialist—........ Scientist............-----................. Medical literature analyst................. Searcher................................... Supervisory programer.................... Digital computer systems administrator... Systems analyst (2)........................ Librarian.................................. Public health program specialist........... Medical literature analyst----............ Searcher-------........................... Indexer (4)...........------------------- Senior programer.......................... Secretary-------------......------------ Secretary....................—---....... Secretary (3)............................- Clerk-typist (2)........................... Input typist (2)...............-_........ Total, library operations (42). Review and approval of grants and contracts: Public health program specialist........... Regional resources officer---------------- Training officer.................-.......... Grants management officer-------------- Construction officer........------------- Publication officer___.................... Grants assistant (2)............---------- Total, Review and approval of grants and contracts (8). Total new positions, all activities (50).................. GS-15 GS-15 GS-15 GS-15 GS-15 GS-15 GS-14 GS-14 GS-14 GS-14 GS-14 G8-14 GS-13 GS-13 GS-13 GS-13 GS-13 GS-13 GS-13 GS-12 GS-12 GS-12 GS-12 GS-12 GS-12 GS-9 GS-7 GS-5 GS-5 GS-2 GS-14 GS-14 GS-14 GS-13 GS-13 GS-11 GS-5 $17,650 35,100 17,660 17,550 17,550 17,550 30,212 45,318 15,106 15,106 15,106 16,106 12,873 12,873 12,873 12,873 12,873 12,873 25,746 10,927 10,927 10,927 10,927 43,708 10,927 7,696 6,451 15,993 10,662 7.850 508,783 15,106 15,106 16,106 12,873 12,873 9,221 10,662 9ft 947 599,730 MEDICAL JOURNALS PUBLICATIONS Senator Hill. Now, Dr. Cummings, National Library of Medicine. Glad to have you here with us, Doctor. Dr. Cummings. Thank you, Mr. Chairman. I have with me Dr. Marjorie Wilson, director of the extramural programs; and James Isbister, our executive officer. Senator Hill. They are your brain trusters ? Dr. Cummings. Yes, sir. . Mr. Chairman, since the beginning of the modern scientific era in the mid-17th century, the fund of human knowledge is estimated to have doubled every 15 years. The increasing investment of resources in recent years devoted to improving health has stimulated the publica- tion of information at a rate which has overloaded all health science information channels. Today there are more than 6,000 different medi- cal journals published in the world.0146260_000017.txt

Page  17 1604 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Senator Hill. What approximate percent of these would you say are published here in this country ? Dr. Cummings. Less than half of them are published in the English language, and perhaps less than 30 percent are published in the United States. These periodicals contain approximately 250,000 articles each year written in 40 different languages. Based on historical evidence, this periodical literature will double again in about 12 years. TECHNICAL REPORT LITERATURE In addition, the technical report literature produced by Government contractors is expanding at an enormous rate. National and interna- tional scientific meetings produce still more information important to the growth of the health sciences. All of these elements contribute to a critical information overload. INFORMATION Coixection, Organization, and Dissemination Good communication among all members of the biomedical com- munity is essential in improving health. Ineffective communication inhibits the progress of research and the application of new findings in the treatment of patients. The health researcher finds it increasingly difficult to be aware of the specialized literature pertaining to his fields of inquiry. With present methods, the average health practitioner finds it virtually impossible to keep abreast of the literature; his efforts to maintain awareness of recent medical findings are thwarted by a maze of uncoordinated information sources. Senator Hill. It is a problem, isn't it ? Dr. Cummings. I think it is a very significant problem. Scientific progress which created the information problem offers the best hope for its solution. Many technological advances which have enabled the scientific community to increase the rate of data genera- tion and analysis provide the means for improved collection, organiza- tion, and dissemination of information. Solutions to the technical problems of the information explosion lie in the application of new technology to specific needs in the areas of information management and transmission, graphic image informa- tion storage and retrieval, and direct man-machine communication. We are studying these problems and developing new applications for their solution. Management The National Library of Medicine has been concerned with the in- formation management problem for over a hundred years. Since 1879 the Federal Government has accepted responsibility for the publica- tion of indexes and bibliographies in the medical sciences as guides and major resources for the medical community.0146260_000018.txt

Page  18 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1605 BIOMEDICAL LITERATURE REPOSITORY The National Library of Medicine, with its collection of nearly 1.3 million books, journals, theses, photographs, and other records consti- tutes the ultimate repository of the world's biomedical literature. The National Library of Medicine is the largest and most comprehensive research library m any field of science. INFORMATION TRANSMISSION But the Library is more than a passive repository of information. It is, in fact, an active information center, utilizing a variety of modes and mechanisms of information transfer. During 1966 the Library indexed 164,545 journal articles, performed more than 3,000 com- puter-generated demand searches, published 47 major recurring de- mand search bibliographies, provided 152,000 interlibrary loans, and answered 21,871 reference inquiries. Senator Hill. It keeps your staff pretty busy, doesn't it? Dr. Cummings. It keeps them hopping. BIBLIOGRAPHIC AND REFERRAL SERVICES In addition, it provided bibliographic and referral services through Index Medicus, Cumulated Index Medicus, Current Catalog, Bibliog- raphy of Medical Keviews, and Bibliography of Medical Transla- tions. It responded to 91,000 reader requests within the Library and photographed 3.4 million pages for preservation and distribution. INFORMATION STORAGE AND RETRIEVAL MEDLARS In an effort to provide more rapid access to the flood of new publi- cations, the NLM developed the MEDLAES system, one of the world's largest computer-based information systems. MEDLAES combines the talents of trained literature analysts and the processing capabilities of a high-speed electronic computer. The literature analysts, using terms selected from medical subject headings (Mesh), the master key to MEDLARS, index biomedical journal articles, and assign the Mesh terms which describe the articles' con- tent. These data are entered into the computer and transferred to mag- netic tapes for storage and rapid retrieval. The MEDLAES files now contain over 500,000 citations to biomedical journal articles published since January 1964. Index Medicus In addition to providing a rapid and efficient method for producing the monthly Index Medicus, a comprehensive index to articles from approximately 2,300 biomedical journals, and an annual Cumulated Index Medicus, the Library's computer operation permits rapid ma- chine reference searches. These computer searches provide health sci- entists, educators, and clinicians rapid and easy access to the bio- medical literature in broad areas of medical interest.0146260_000019.txt

Page  19 1606 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS BIBLIOGRAPHY PUBLICATIONS To provide extensive circulation of these references in specialized medical subject areas, the Library cooperates with nonprofit profes- sional organizations and other Government agencies in producing pub- lished recurring bibliographies, for distribution to groups of workers in various specialized fields. MEDLARS SYSTEM To facilitate local access to the MEDLARS system, the Library supports five decentralized MEDLARS search centers at the Uni- versities of California (Los Angeles), Colorado, Alabama, and Mich- igan, and Harvard University. The demands for MEDLARS searches this year at one point ex- ceeded our human resources to provide these services, forcing us to declare a 6-week moratorium on the processing of new requests for demand searches. Thus, Mr. Chairman, an increase of 11 positions and $259,200 is needed in 1968 to meet the expanding indexing and com- puter search formulation workload. Bureau of the Budget Reduction Senator Hill. Did the Budget Bureau allow you these figures? They cut you down some; did they not ? Dr. Cummings. We did have---- Senator Hill. The Department cut you quite a bit and then the Budget Bureau cut you quite a bit ? Dr. Cummings. Well, the Department, I think, was quite generous with respect to our budget submission, but the Bureau of the Budget in effect reduced our request by some 30 percent. Senator Hill. According to the figure I have here, they cut you some $8,117,000. Dr. Cummings. The Bureau of the Budget cut was in that amount; the Department cut was much smaller. Senator Hill. A million dollars. But that gave you an overall re- duction of $9,117,000 ? Dr. Cummings. That is correct. Senator Hill. In fact, you got a very small increase over the present year. Dr. Cummings. Our total increase in this budget represents $970,000. Library Construction Reduction Senator Hill. How much are these reductions going to affect you? Dr. Cummings. I think there will be a serious effect on our ability to provide a full range of information services to the biomedical com- munity. In specific terms, the major effects will be to reduce our ability to respond to the Nation's needs for new library construction and to pursue the development of a regional library network. I think more than 50 percent of the Bureau of the Budget cut is in the area of new library construction. The principal effect will be0146260_000020.txt

Page  20 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1607 felt by the universities and medical schools who are in need of the libraries. COMPUTER SYSTEM INSTALLATION We are requesting, Mr. Chairman, $974,900 and eight positions for a new, more efficient computer system. We have almost exhausted the time available on our current computer equipment whose design was frozen 6 years ago. The original system has met expectations for its 5-year period of operation. However, more advanced equipment is required to handle the expanding workload and to allow direct, on- line communication with the computer through remote terminals, a needed feature available in other modern systems. Senator Hill. Will the budget now before us meet this need? Dr. Cummings. Yes; the budget before us, if approved, will meet this need. MEDICAL LIBRARY ASSISTANCE ACT OF 1965 Recognizing that the growth of institutions and mechanisms to collect, organize, and disseminate biomedical information has not kept pace with the information explosion, Congress enacted the Medical Library Assistance Act of 1965. To implement the act Congress provided an increase over the 1967 President's budget of $200,000 for support of the regional medioal library programs and 10 positions and $100,000 for review and ap- proval of grants and contracts. The Congress added an additional nine positions and $668,000 for increased levels of preservation filming, graphic image storage and retrieval, equipment purchases, and develop- ment and direction of the Library's application of advanced technology to biomedical communications. Budget Request Funds to be used in 1968 for programs authorized by the act in- clude : $12,500,000 for construction grants to improve and expand the Nation's medical library facilities---- Senator Hill. How much did you ask for ? Dr. Cummings. We asked for the full amount authorized by the act, $10 million, and we had a carryover of $7.5 million from the current fiscal year as part of the general deferment of new construction starts. Senator Hill. That would give you $17 million ? Dr. Cummings. In effect, we have a deficit of $5 million below our authorization and our planned utilization. Also included in our 1968 program plans are $1.6 million for grants and contracts for research and development directed toward solving some of the difficult problems in storing, retrieving, and transmitting biomedical information; $1.2 million to increase the number and im- prove the quality of librarians and information specialists available to serve the Nation's medical libraries; $100,000 for special scientific projects; $800,000 for support of publications, such as translations, bibliographies, critical reviews, indexes, and abstracts; and $2.5 mil- lion for grants to biomedical libraries for strengthening their re- sources and services.0146260_000021.txt

Page  21 1608 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Regional Medical Libraries Support The Library is currently planning a program to initiate support for six or seven regional medical libraries, and the 1968 budget includes $1.5 million for grants for the. development of existing medical libra- ries as regional service centers to improve and accelerate access to the health science literature. TOXICOLOGICAL INFORMATION SYSTEM DEVELOPMENT An important new responsibility, Mr. Chairman, has been assigned to the Library in the past year." The President's Science Advisory Committee in its report, "Handling of Toxicological Information," published in June of 1966, drew attention to the urgent need for a better coordinated and more comprehensive computer-based file of toxicology information than is now currently available. Recent con- gressional hearings and legislation express wide public concern for this need. Responding to the PSAC report, the President asked the Secretary of Health, Education, and Welfare to be responsible for developing and operating a computer-based toxicological information system. In the foreword to the report, the President said: The number of chemical compounds to which people become exposed is already vast and increasing daily. This is a result of our steadily advancing industrializa- tion, changes in agricultural practices and advances in the biomedical sciences. All segments of our population are exposed either deliberately or in the course of daily living to many such compounds. Senator Hill. Many of these compounds that we thought were so fine have some distinct disadvantages; is that right ? Adverse Effect of Chemical Compounds on Living Systems Dr. Cummings. They have in some cases very profound adverse ef- fects on living systems, be they man, animal, or plantlife. Senator Hill. I recall here not too many years ago when they started feeding chickens antibiotics. They thought that was going to be a great thing, poultry farmers certainly thought so. The chickens grow faster, take less food, and weigh a lot more. What do these antibiotics do to us who eat these chickens ? Dr. Cummings. That is an important question which has been studied for many years. Senator Hill. There is one question that doesn't have to be studied, the chicken doesn't taste nearly as good as it did in the old days? Dr. Cummings. I am not sure I could pass professional judgment on that. Senator Hill. I am not a professional, but I think I can pass judg- ment by saying they don't taste like they did in the old days. See, when the farmer brought that chicken into the town, you nought a chicken, a frver, a broiler. You put him in the chicken coop in the backyard. When you got ready to eat him, you went out and wrung hisneck, soused him in some hot water, took his feathers off took the insides out of him—he tasted a whole lot better than he does todav* is that right ? y' You say you are not qualified to say ?0146260_000022.txt

Page  22 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1609 Dr. Cummings. I have never had the chore of plucking a chicken. Senator Hill. You never plucked a chicken ? Dr. Cummings. The chicken always came in cellophane. It reflects a difference in our ages, Mr. Chairman. Senator Hill. Well, I don't know. I took up here and—with that evidence before me, I will not make any admissions. You don't think the antibiotics in these chickens had anything to do with this scarcity up here, do you ? Dr. Cummings. I don't believe I can attribute scarcity to anti- biotics-fed chickens; perhaps it is related to the hormones that chickens have been exposed to. Senator Hill. I see. FOOD AND DRUG ADMINISTRATION ADVERTISEMENT REGULATIONS Dr. Cummings. Well, Mr. Chairman, we are requesting---- Senator Hill. But we do have these problems, don't we? Dr. Cummings. Yes, we do, and they are real problems. There are, of course, the hidden problems of the chemical environment which is hard to see or smell or taste, but which may have very serious effects on the health of man and animals. Senator Hill. I notice the Food and Drug Administration is going to issue some new regulations about some of these advertisements. You saw that, I suppose? Dr. Cummings. I saw that in the newspapers. Senator Hill. In other words, they advertise what this new com- pound or this new drug will do, but they don't say anything about some harmful effects that might come from it. Dr. Cummings. This is unfortunately true. Senator Hill. That is what it is. I don't look at TV much, but you cannot turn on TV that you don't get cigarette advertisements, and "they are mild." All right, go ahead, Doctor. Dr. Cummings. Mr. Chairman, we are requesting $900,000 and 20 positions---- Senator Hill. By the way, still off the record. (Discussion off the record.) Senator Hill. On the record. TOXICOLOGY INFORMATION EXCHANGE Dr. Cummings. We requested $900,000 and 20 positions to begin development of a toxicology information exchange which will inform the public as well as physicians and scientists of toxic effects of drugs and chemicals on man and his environment. NEW OBLIGATIONAL AUTHORITY REQUEST In summary, our total request is for $21,162,000 in new obliga- tional authority representing a net increase of $970,000 over the amount appropriated in 1967. The principal items of increase are for devel- opment of a new computer system and a toxicology information ex- change, and for regional medical library grants. I shall be pleased to try to answer any questions you might have.0146260_000023.txt

Page  23 1610 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS GRAPHIC IMAGE STORAGE AND RETRIEVAL Senator Hill. Doctor, you recall last year the House added $550,000 and the Senate concurred in this addition for graphic image storage and retrieval ? Dr. Cummings. Yes, sir. . i__i_ Senator Hill. I recall a few years ago you brought several dooks of medical literature with the pages disintegrating and falling apart. What is the situation with reference to this project now ? Dr. Cummings. Well, I am pleased, obviously, with the action taken by the House and Senate last year, because it has made it possible tor the National Library of Medicine to undertake to capture the images of these deteriorating documents before they, in fact, disappear. We are on target with respect to our projections of the number of pages that would be filmed. We have about 2.8 million pages already filmed, and my staff informs me that at least the same amount and perhaps a larger number of pages will be filmed with the funds still available to us, so that in the aggregate I would expect that perhaps more than 6 million pages of our deteriorating collection will be on archival and working film. Senator Hill. So you think, then, you are making progress with this project? Dr. Cummings. Yes, there is no question in my mind that these funds have been put to good use and will keep the recorded knowledge avail- able within the national library. HISTORY OF MEDICINE Senator Hill. Several years ago the Congress added funds to begin a program on the history of medicine and I believe in the second year we here in the Senate had to restore funds cut back by the Budget Bureau for this project. What is the status of this project now ? Dr. Cummings. The program is moving forward, I think, in a very fine way and I would like to ask Dr. Wilson, with your permission, to give you a brief report on the progress made. Senator Hill. All right, Doctor. Dr. Wilson. Yes, indeed. We have continued the history of medi- cine program, and this year I can tell you we have 19 research projects in the area of history of medicine and two very fine training grants which provide graduate training. These are for individuals both pre- doctoral and postdoctoral, most of whom have scientific backgrounds, some M.D.'s some Ph. D.s, to obtain additional training in history. This provides the country with individuals who can train others in the history of medicine. Many medical schools, for example, are looking for people to establish departments of history of medicine. The program has actually increased some within the appropriation. Senator Hill. You increased it some with this appropriation ? Dr. Wilson. Yes. Senator Hill. How far back in the history of medicine can you go, Doctor? Dr. Wilson. Well, back to the---- Senator Hill. I don't mean you can speak from firsthand knowl- edge ; I don't imply that at all.0146260_000024.txt

Page  24 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS 1611 Dr. Wilson. Back certainly to the beginnings of medical practice and medical knowledge and scientific knowledge relating to medicine. Senator Hill. That would be what year B.C. ? Early Chinese and Egyptian Medicine Dr. Cummings. I think one can go back to the early Chinese and Egyptian medicine, which is probably at least 20 or 30 centuries B.C. and go back to the clay tablets and papyri, among other forms. But I think it would be unfair to leave you with the impression that the scholars who are being supported through this program are, in fact, replowing that part of antiquity alone. They are concerned also with the 17th, 18th, and 19th centuries, to reexamine their influence on current medical practice, trying to search for unexploited opportunities through these reviews. Senator Hill. I don't imagine Imhotep influences medicine too much today, does he ? Dr. Cummings. I don't think so. Senator Hill. He is a little too far back, isn't he? Dr. Cummings. I wouldn't say any recorded knowledge is too far back, but I think the rediscovery of knowledge from that period of history may not be as significant as a reexamination of more current history. CONTEMPORARY MEDICINE EXAMINATION It gives me an opportunity to tell you also, Mr. Chairman, that the library is carrying out an exciting new program in the examination of contemporary medicine through the use of modern devices such as the tape recorder. We are now able to capture from direct dialog with leaders of contemporary medicine much of the unwritten record of their influences on advances in medicine. This is a very exciting new program. Senator Hill. But most interesting, is it not ? Dr. Cummings. I think it is a most interesting program, not so much for what we may gain today, but for what future scholars may gain b}T having access to this kind of record. REGIONAL MEDICAL LIBRARY DEVELOPMENT Senator Hill. Would you say most of the reduction made in your request would go to the matter of funds for regional libraries? Dr. Cummings. Well, most of the reduction was applied to con- struction grants. That is a $5 million reduction. The second largest reduction was for research—$1,400,000. Also we were reduced by $1 million for regional medical library devel- opment. Senator Hill. That wrould slow up your program, wouldn't it? Dr. Cummings. It will have a delaying effect on implementing this program. Fortunately, however, sufficient funds were left in the budget to give us an opportunity to establish six or seven regional libraries in the next fiscal year, and we would be hopeful perhaps of building upon this in the subsequent fiscal year.0146260_000025.txt

Page  25 1612 LABOR-HEALTH, EDUCATION, WELFARE APPROPRIATIONS Senator Hill. But you would have funds for six or seven in the coming fiscal year ? Dr. Cummings. Yes. We were given $200,000 for planning the re- gional medical library program in 1967 and we have $1.5 million in the fiscal year 1968 budget to implement the program. I think this will give us the opportunity to make a very good start. Dr. Wilson and her staff have met with at least 12 communities who have expressed interest in providing regional library services. PROGRAM TO MAKE INFORMATION READILY ACCESSIBLE She has recently summarized this program plan as well as the action plan, which, in my view, will provide the beginning of an ef- fective medical library network. Ultimately we believe this network will provide the important mechanism for making information readily accessible. We are really not so much interested in the library as an institution as we are interested in using it as an instrument for getting informa- tion to the physicians who treat patients, Mr. Chairman. Senator Hill. The fellow at the bedside, is that correct? Dr. Cummings. That is correct. The library, we believe is a chan- nel to accomplish this. All of these projgrams are geared to the end- user, with the library being the transmission link, if you will. Senator Hill. We need to acquire more knowledge, of course, much more knowledge but it is also important that when we get the knowl- edge, we must disseminate it to the user; is that right? Dr. Cummmings. That is correct, that is our philosophy at least. Senator Hell. And then this is something you and I cannot do any- thing about, I guess. I think we need a little more dedication on the part of some of the users today ? Dr. Cummings. Yes, I thmk that is an educational problem more than anything else. Senator Hill. Anything you would like to add, Doctor? Dr. Wilson. No, thank you. Senator Hill. You would not have to have any fears of any com- ment here. Anything else, Doctor? Dr. Cummmings. No, thank you for this opportunity. Senator Hill. We certainly want to thank you all very, very much. We deeply appreciate your statement.