1971 U.S. House of Representatives Appropriations Committee Budget Testimony, 91st Congress 2nd Session, 1970
Page  1

&• S1. Co/-(?"-es?. *-'€■:; St.Co/r/m/ttee I" or -if- c&Hs,t/o/-?$. DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE APPROPRIATIONS FOR 1971 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES NINETY-FIRST CONGRESS SECOND SESSION SUBCOMMITTEE ON DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES DANIEL J. FLOOD, Pennsylvania, Chairman WILLIAM H. NATCHER, Kentucky ROBERT H. MICHEL, Illinois NEAL SMITH, Iowa GARNER E. SHRIVER, Kansas W. R. HULL, Jr., Missouri CHARLOTTE T. REID, Illinois BOB CASEY, Texas Robert M. Moyer, Henry A. Neil, and Thayer A. Wood, Staff Assistants PART 3 NATIONAL INSTITUTES OF HEALTH Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 45-517 O WASHINGTON : 19700410415_000002.txt

Page  2 1324 NATIONAL LIBRARY OF MEDICINE WITNESSES DR. MARTIN M. CUMMINGS, DIRECTOR DR. ROBERT Q. MARSTON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH DR. G. BURROUGHS MIDER, DEPUTY DIRECTOR, NATIONAL LIBRARY OF MEDICINE DR. LEROY L. LANGLEY, ASSOCIATE DIRECTOR, EXTRAMURAL PROGRAMS, NATIONAL LIBRARY OF MEDICINE GEORGE F. RUSSELL, JR., EXECUTIVE OFFICER, NATIONAL LI- BRARY OF MEDICINE LELAND B. MAY, ASSISTANT DIRECTOR OF FINANCIAL MANAGE- MENT (BUDGET), NATIONAL INSTITUTES OF HEALTH JAMES B CARDWELL, DEPUTY ASSISTANT SECRETARY, BUDGET National Library of Medicine1 OBJECT CLASSIFICATION (in thousands of dollars) 1969 actual 1970 estimate 1971 estimate Personnel compensation: Permanent positions_____....................----------..... Positions other than permanent...............-----........... Other personnel compensation..................---------..... Total personnel compensation.....-------.....------------- Personnel benefits: Civilian employees................------------ Travel and transportation of persons......________________________ Transportation of things..............................----------- Rent, communications, and utilities..........--------------....... Printing and reporduction..................-----------........... Other services..«_____.......................---------.........-- Supplies and materials.............................------------- Equipment......................................--------------- Grants, subsidies, and contributions...............________________ Subtotal............................--------------------- Quarters and subsistence charges............--------------------- Total obligations..................___________________..... PERSONNEL SUMMARY Total number of permanent positions.............................. Full-time equivalent of other positions________.....________________ Average number of all employees_________________________________ Average GS Grade...............___________________________..... Average GS Salary........_________________________________..... Average salary of ungraded positions_________________________..... 4,861 5,424 155 89 5,648 166 158 88 89 5,115 5,668 5,905 428 481 498 135 167 167 13 33 33 421 1,510 1,704 298 403 468 5,374 4,853 4,624 285 333 245 546 388 363 9,154 6,157 19,993 -30 5,792 21,769 19,799 -30 -30 21,739 19,963 19,769 472 467 467 20 18 18 491 485 485 8.2 8.3 8.4 $10,089 $11,315 $11,503 57,972 $8,481 $8,567 0410415_000003.txt

Page  3 1325 PROGRAM AND FINANCING (IN THOUSANDS OF DOLLARS) 1969 actual 1970 estimate 1971 estimate Program by activities: 1. Grants for support of medical libraries... -3 104 6 157 5 792 2. Direct operations: (a) Lister Hill National Center for Biomedical Communica- tions_______________________ (b) National Medical Audiovisual Center.. (c) Library operations______________ (d) Toxicology information____________ (e) Review and approval of grants... (f) Program direction......________________________ Total, direct operations......._______________ Total program costs, funded2................. Change in selected resources3-.......______......._______ Total obligations...........................___________ Financing: Recovery of prior year obligations....._____________________ Unobligated balance available, start of year_________________ Unobligated balance available, end of year__________________ Unobligated balance lapsing_______........_______________ Budget authority.............-------------------------- Budget authority: Appropriation.......-------------------------------...... Transferred to other accounts........______________________ Appropriation (adjusted)________________________________ Relation of obligations to outlays: Obligations incurred, net___________________________________ Obligated balance, start of year____________________________ Obligated balance, end of year..........................._ Adjustments in expired accounts____________........._____ Outlays...............____________........_.....___________ 17,050 24,730 21,924 818 1,838 898 2,050 7,160 1,507 604 1,587 906 1,799 5,519 1,380 7 592 1,185 684 623 1 544 1,872 11,783 13,806 13,977 8,679 19,963 19,769 13, 060 21, 739 19,963 19,769 -221 -4,117 -700 700 60 310 ... 18,160 19,573 19,769 18,160 19,682 -109 ... 19,769 18,160 19,573 19,769 21,518 22,070 -26,430 -108 .. 19,963 26,430 -21,663 19,769 21,663 -19, 508 > The 1970 appropriation bill had not been enacted at the time the 1970 budget was printed. The 1970 column of the budget schedules reflects the amounts carried in the 1970 budget The figures for 1970 in the justification material following the hearings on this appropriation item have been adjusted to reflect the enacted appropriation. 2 Includes capital outlay as follows: 1969, $546,000; 1970, $388,000; 1971, $363,000. 3Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1968, $7,037,000(1969 adjustments, $5,316, 000); 1969, $25,413,000; 1970, $25,413,000; 1971, $25, 413,000. Mr. Hull. We will now hear from the National Library of Medi- cine. Dr. Martin M. Cummings, Director, will present the statement. Please proceed, Doctor. INTRODUCTION OF SUPPORTING WITNESS Dr. Cummings. I would like to take a moment to introduce a new member of our staff who has never had the opportunity to meet with this committee: Dr. Leroy L. Langley is the new Associate Director for Extramural Programs. He comes to us from the National Heart and Lung Institute. He has had an interesting background as teacher of medicine and science. He is an attorney and, I might add, a dis- tinguished writer so we are very pleased to have him with us. Biographical Sketch of Dr. Maetin M. Cummings Name: Martin Marc Cummings. Position : Director, National Library of Medicine. Birthplace and date: Camden, N. J., September 7,1920. Education: B.S., Bucknell University, 1941; M.D., Duke University School of Medicine, 1944; Mixed Internship, Boston Marine Hospital, 1944-45 ; Assistant Resident, Medicine, Boston Marine Hospital, 1945-46.0410415_000004.txt

Page  4 1326 Experience: Director, National Library of Medicine, 1964 to present; Associate Director for Research Grants, NIH, 1963; Chief, Office of International Re- search, NIH, 1961-63; Chairman and Professor, Department of Microbiology, University of Oklahoma School of Medicine, Oklahoma City, Okla., 1959-61; Director, Research Services, Veterans Administration Central Office, Washing- ton, D.C., 1953-59; Special Lecturer in Microbiology, George Washington Uni- versity School of Medicine, Washington, D.C., 1953-59; Chief, Tuberculosis Research Laboratory, Veterans Administration Hospital, Atlanta, Ga., 1949-53; Associate Professor of Bacteriology, 1953, and Instructor through Associate Professor of Medicine at Emory University School of Medicine, Atlanta, Ga., 1948-53; Director, Tuberculosis Evaluation Laboratory, Communicable Disease Center, U.S. Public Health Service, Atlanta, Ga., 1947-49; U.S. Army, 1942- 44, Pfc. Association memberships : American Academy of Microbiology, Inc.; American Board of Microbiology ; American Federation for Clinical Research—Emeritus; American Society for Clinical Investigation—Emeritus Member; Amer- ican Thoracic Society; Association of American Medical Colleges; Medical Library Association; The Society of the Sigma XI; Council of Biology Editors, Inc.; American Clinical and Climatological Association; American Association for the History of Medicine; Board of Directors, Gorgas Memorial Foundation; Board of Directors, Association of Research Libraries; Board of Visitors of the Medical Center of Duke University. Special awards, citations, or publications: VA Exceptional Service Medal; DHEW Superior Service Award; DHEW distinguished Service Award; Hon- orary Degree, Doctor of Science, Bucknell University; Distinguished Alumnus Award, Duke University. General Statement Dr. Cummings. Mr. Chairman and members of the committee; the National Library of Medicine enters the new decade as the principal curator and organizer of the published record of biomedical knowl- edge while actively disseminating biomedical bibliographic, textual, and audiovisual information. The collection of 1.3 million items is uni- quely organized and available to meet the needs of the health pro- fessional community. Consequently, in 1971 the Library will re- spond to 115,000 requests for interlibrary loans and 81,000 requests from readers in the Library reading rooms. The National Library of Medicine will also index 230,000 articles in periodicals of the health sciences, catalog 17,500 books and monographs, and produce 24,000 computer searches of the biomedical literature on request. Thus, the Library serves medicine and the allied health professions within its facilities and by extensive lending of its materials. ROLE OF MEDLARS The computer-based medical literature analysis and retrieval sys- tem (MEDLARS), now 6 years old, has steadily grown to contain over 1 million bibliographic citations on 48 reels of magnetic tape. Dur- ing this period the annual number of articles indexed for the sys- tem has risen from 144,000 to 230,000; the number of demand searches generated has risen from less than 1,000 annually to 20,000 in 1970. MEDLARS continues to produce "Index Medicus," the comprehensive monthly bibliography to the most significant portion of the world's biomedical literature; 'Commulated Index Medicus" (an annual 10,000-page product); Current Catalog, which provides cataloging information to libraries throughout the world; and 17 recurring bibliographies, prepared for and supported by various Federal agen- cies and professional organizations, which are sold by the Superin- tendent of Documents.0410415_000005.txt

Page  5 1327 NEW PUBLICATION TO AID PHYSICIANS AND MEDICAL LIBRARIANS The first issue of "Abridged Index Medicus," published in Jan- uary 1970, and cosponsored by the Medical Library Association, is designed to afford rapid access to a selected group of 100 English language biomedical journals of particular interest and pertinence to practitioners of medicine. These journals are quite readily avail- able in comparatively small hospital libraries. Initial response from physicians, medical librarians, and medical editors has been enthusi- astically favorable. COOPERATION OF THE MEDICAL COMMUNITY WITH MEDLARS I MEDLARS I has been a shared intellectual endeavor in its 6 years of operation. Particularly, health professionals have come forward with pertinent and helpful suggestions for modifications and im- provement of the system. In more recent years the awesome task of indexing the world's medical articles, originally limited to National Library of Medicine staff, has been shared with NLM-trained litera- ture analysts in other areas of this country as well as in several other countries. PROGRESS OF MEDLARS II MEDLARS II is now under development to respond to growing demands upon MEDLARS I to improve specificity of recall through a greatly augmented, controlled vocabulary and to create more on- line capabilities. Whereas MEDLARS I is basically a bibliographic retrieval and publication system, MEDLARS II is being developed as a total automated library system that will include such library processing capabilities as acquisition and ordering, cataloging, inter- library loan activities, vocabulary browsing, and improved manage- ment information controls. The overall functional system design and procedural design for the initial phase of the system are essentially complete, and the initial system is to be delivered in the late summer of 1970. Most of the equipment for MEDLARS II has already been installed for operational evaluation. It will be necessary, however, to continue to process materials with MEDLARS I in parallel with the new system for at least the first 6 months after implementation of MEDLARS II to be certain of its capabilities before retiring the original system. RESTORATION OF LIBRARY SERVICES TO FOREIGN REQUESTERS ON A FEE FOR SERVICE BASIS Personnel ceilings in 1970 made it necessary to discontinue inter- library loan services, MEDLARS searches, other reference services, and film loans to foreign countries not covered by the National Li- brary of Medicine agreement with the Agency for International De- velopment. These services are being restored in response to urgent requests from members of the biomedical community abroad who have depended upon the unique resources of the National Library of Medicine throughout its history. Restoration of the foreign serv- ices will require payment of a fee for service to recapture the costs 46-517—70—pt. 3---840410415_000006.txt

Page  6 1328 of handling and postage for the U.S. Government. The fee for an interlibrary loan will be $2. Fees will also be instituted for film loans and MEDLARS computer searches. REORGANIZATION OF THE ACTIVITIES OF THE NATIONAL MEDICAL AUDIOVISUAL CENTER The National Medical Audiovisual Center (NMAC) has served as the focus of Federal activities for the production acquisition, and distribution of audiovisuals in the health sciences. In line with a recent recommendation from the Board of Regents of the NLM, the Center will devote more of its resources to acquisition, organization and distribution of audiovisual materials, and less to their production. This is noted in a decrease in motion picture film production from 30 in 1970 to a projected 20 in 1971, and also a decrease in TV video- tapes production from 34 to 30. Reallocation of personnel and the decrease in production will permit an increase in the acquisition and distribution of new audiovisuals. An increase of 50 new titles is an- ticipated, and an increase in the number of loans is projected from an estimated 83,000 in 1970 to 100,000 in 1971. This is obviously not an end to production; in fact as part of the NMAC reorganization it is anticipated that the unique facilities and technical staff in Atlanta will be made available to members of university and medical school faculties in order to marry the NMAC technical expertise to the scholarly competence of those responsible for medical school curricula to create audiovisual and other teaching materials of excellence for national use. Productions should be innovative to capitalize on newly developing materials and new methods for displaying and trans- mitting information. LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS The Lister Hill National Center for Biomedical Communications serves as the DHEW focal point for the coordination of biomedical communications systems and network projects. It has moved forward on several fronts. The Center, for example, has completed plans for experimental use of teletypewriter terminals and TWX lines to pro- vide access to bibliographic citations to the current medical literature stored in an on-line time-sharing computer. The system will permit users to search the bibliographic citations that appear in the 100 jour- nals included in the "Abridged Index Medicus" for the price of a tele- phone call. Using satellite communications technologies, the Center is cooperating with the National Aeronautics and Space Administration, the University of Wisconsin, and Stanford University to develop tech- nical experiments which would permit verbal consultation between re- mote areas of Alaska and the Pacific Basin and the medical facilities of Stanford, Wisconsin, and the National Institutes of Health. I might say, Mr. Chairman, the first successful demonstration of this 4-way linkage took place about a week ago. The Center is also involved in a project with the Association of American Medical Colleges in studying the all-important problem of content selection for programs directed at both undergraduate and graduate medical education. The Center has also committed itself to develop a communications network for Vermont and New Hampshire physicians to assist in continuing education and patient care activities.0410415_000007.txt

Page  7 1329 MEDICAL LIBRARY ASSISTANCE ACT SUPPORT PROGRAMS Through the Medical Library Assistance Act of 1965 (Public Law 89-291) the Nation's medical libraries have gained much needed sup- port. Funds have already been provided to 62 health sciences libraries, 38 medical libraries, 16 dental libraries, and 30 libraries of schools of pharmacy, as well as 194 hospital libraries in 49 of the 50 States, for the enrichment of their book and journal collections, the strengthening of their professional staff, and the improvement of reader services. The regional medical library program utilizes selected institutions as readily accessible backup facilities to smaller libraries. The selected libraries are chosen on the basis of their geographic location and the size and scope of their collections. The objective is to facilitate access to existing library resources, thus to prevent unnecessary duplication by proliferation of a great variety of libraries to serve the health team. REGIONAL MEDICAL LIBRARY NETWORK In 1970 ten regional medical libraries, which will include the two new regional libraries to be established in Texas and Nebraska (but not the NLM, which serves also as the Mid-Atlantic regional library), will have provided 217,000 interlibrary loans and performed 4,400 MEDLARS demand searches. It is important to realize, however, that four of the ten regional libraries have been operational for less than a year. In addition to these services the regional libraries provide reference, consultation, and educational services. TOXICOLOGY INFORMATION PROGRAM Responsibility was delegated to the NLM for implementing the toxicology information program, a nationwide toxicology informa- tion system to provide data on the harmful effects of chemical compounds on humans promptly and efficiently. In 1970 steps toward development of a computer based system included development of registry numbers and approved names for some 30,000 chemicals, the consolidation of toxicity information on approximately 1,000 chem- icals, and development of storage and retrieval software. The em- phasis in 1971 will be on introduction of new, useful products and services to meet specific user needs, based on guidance received from the National Academy of Sciences-National Research Council, and evaluation of user study findings. Pesticides and environmental toxi- cants will receive first attention. In addition, a bibliography on environmental health is under development. The NLM now serves as a broadly based information and communi- cations center for American medicine. At the same time that it has continued to serve physicians, scientists, educators and students from its national facility, it has upgraded the Nation's other medical li- braries through its extramural programs. In summary our request for 1971 is $19,769,000, a net decrease of $193,679 from the obligation level for 1970. The net decrease results from mandatory increases of $506,000, including within-grade in- creases and payment to the NIH management fund; program increases of $335,000, largely for library operations related to MEDLARS II; and offsetting decreases of $1,034,679 for reductions in the toxicology0410415_000008.txt

Page  8 1330 information program, the operating level of the National Medical Audiovisual Center, and the funding level for research grants. I will be pleased to answer any questions you may have, Mr. Chairman. FISCAL CONSTRAINTS Mr. Hull. Dr. Cummings, if we only talked about your program increases, we wouldn't have much to discuss with you, would we ? Dr. Cummings. No, sir. Mr. Hull. You have six grant programs and not one of them has sufficient funds to award any new grants in 1971, although I see you are continuing most of the existing grants. Is this all due to the cur- rent fiscal stringency or is it planned to phase out some of your grant activities ? Dr. Cummings. We have no plans to phase out any of our grant activities. The inability to support new projects is purely based on fiscal constraint. GRANTS FOR LIBRARY RESOURCES Mr. Hull. Your largest grant program is $2,105,000 for library resources. In the justification you say you are shifting from formula grants to "a system which will encourage innovative plans for new and expanded services to users." How will the new system do this? Dr. Cummings. Mr. Chairman, in the first 5 years of this program, the obvious need was to build a sufficient library base within local community hospitals and other medical libraries so that there was an adequate resource to serve the nearby community of users. Having accomplished this, we now believe that resource funds ought to be given to those institutions which demonstrate that they have a new method or a new approach to improving the speed or the comprehensiveness of service. This will be done by reevaluating each institutional grant application as it comes up for renewal and giving higher priority to service innovations than to building of collections. REGIONAL MEDICAL LIBRARIES Mr. Hull. Will you explain how the regional medical libraries op- erate, and tell us what expenses are covered by this appropriation? Dr. Cummings. Yes, sir. The regional library program is based primarily on providing funds to an existing institution already known to have an outstanding collection with their agreement to give serv- ices beyond their normal community of users. Thus, for example, the New England Regional Library, which is based in Boston, has agreed to serve all of the States of New England. They are reimbursed for the services that they provide in lending their material to physicians, educators and scientists in those States; for giving reference and bibliographic services; and for giving as- sistance through educational programs involving improved library services. These in fact, Mr. Chairman, are programs which I have often felt could be supported as readily through a contract as through a grant because they are service oriented, unlike most other extramural pro- grams.0410415_000009.txt

Page  9 1331 PUBLICATION SUPPORT Mr. Hull. For publication support you are requesting $267,000, the same as the amount you had for 1970. Who gets these grants and how do you avoid the possibility that what you pay to have published would have been published anyway without the necessity of spend- ing Federal funds ? Dr. Cummings. This is a very important question and one which I will invite Dr. Langley to elaborate on. As a matter of policy, the National Library of Medicine has only supported publications which are known not to be economically viable to the commercial industry. They are primarily publications that we ordinarily call secondary publications such as handbooks, abstracts, indices, and importantly the publication of science that was performed abroad and which was translated into English to make this knowledge available to Ameri- can science. Dr. Langley has recently completed an analysis of this program and has some very interesting ideas as to how it may serve our Na- tion's needs even more efficiently. I would like to ask him to describe this. INTERNATIONAL PROGRAM Dr. Langley. The publication program is tied in with our inter- national program which is supported by Public Law 480 funds. The object of this Public Law 480 program is to utilize these funds in countries such as Israel and Poland and Yugloslavia to prepare criti- cal reviews and to prepare other works of value for use by U.S. scien- tists, and to translate known volumes that are needed by the scientists in this country. Once they are prepared, then it is necessary to have them published and to have them widely promoted and distributed so that all the scientists in this country may have access to them. There are several ways of doing that. One is to use funds in the publication program to pay the Government Printing Office to have these volumes published. Aiiother way is to have the works translated and printed in a foreign country and then to arrange here with a commercial company for distribution, under a contractual arrange- ment by which the company is reimbursed for promotion and for dis- tribution, but without profit. To answer your specific question as to how we avoid subsidizing work which a commercial publisher might publish, this is one of the criteria which is used in order to satisfy that requirement. In other words, before we give a grant for a publication there must be evidence that the work has been submitted to commercial publish- ers and the commercial publishers have turned it down, not on the basis of merit but on the basis of economic considerations. COMPUTER-BASED PROBLEM-ORIENTED MEDICAL RECORD SYSTEM Mr. Hull. Under the Lister Hill Center, what is this experiment which the justifications say is "centered on the University of Ver- mont's computer-based problem-oriented medical record system?"0410415_000010.txt

Page  10 1332 Dr. Cummings. Mr. Chairman, the University of Vermont through its faculty has developed, we believe, a very important program which is designed to assist medical students and physicians in the creation of medical records and importantly in their analysis. This system, developed by Dr. Lawrence Weed, has been tested in several local communities and has been found to be useful on a local V\QGlg We have reviewed and accepted for partial support a proposal from Dartmouth Medical School and the University of Vermont to place this program on a regional basis within this sector of the New Eng- land area. The intention is to link the community hospitals in New Hampshire and Vermont to the two medical schools and to allow physicians as well as the medical students and related health staff in the teaching hospitals to gain experience with the use of this program and hope- fully to demonstrate its utility in the practice of medicine. TOXICOLOGY INFORMATION PROGRAM Mr. Hull. Who will be the principal users of your services under the toxicology information program when it is in full operation? Dr. Cummings. There will be three categories of principal users. One is physicians and public health officials who are faced with the problem of drug toxicity, adverse reaction to drugs and chemicals and the like. Second, the drug industry itself, which has a keen interest in learn- ing of the biologic effects of products that they generate before and after they are in wide use. Third, we believe that the academic community, which is develop- ing more intense interest in pharmacology and toxicology as a disci- pline of medicine, will make use of the data they can derive from these programs. TRANSFER OF ACTIVITIES Mr. Hull. What activities, Doctor, that have been carried on by other Federal agencies will be transferred to this program ? Dr. Cummings. No activities will be transferred to this program. This program is attempting to integrate, wherever possible, existing files in a compatible fashion so that all existing programs can relate to each other technically. Thus, for example, the open chemical files of the Food and Drug Administration register compounds in the same way that we register compounds through the American Chemical Society. Every drug and chemical will have a unique address just as you and I have unique telephone numbers. This is a remarkable advance even though it sounds simple. Unfortunately in the past this hasn't been the case. Drugs and chemicals go under many different names, including trade names and chemical and generic names. All of these factors will be brought to- gether in a standardized file. However, no other program will be transferred to this activity. This activity is merely establishing the format for compatible interchange of information among the various existing programs.0410415_000011.txt

Page  11 1333 MEDLARS II Mr. Hull. When will the second generation of MEDLARS be in full operation? Dr. Cummings. If our contractor delivers as we hope he will, the first level of MEDLARS II will be operational in September of this year. ^Zt^^S? JY1*** wiU the advantages of MEDLARS II be over MEDLARS I? • D^t Cummings. Ifc wiH have several principal advantages. One, it will allow us to continue to enlarge the data base. Two, it will process the request for information more rapidly and more efficiently than the present first generation system. Third, it will provide for the mechanization of library tasks other than bibliographic services. It will mechanize our ordering, technical services, and recordkeep- ing; it will mechanize our cataloging services and will have manage- ment information controls built into it. Thus we hope it will make the entire library operation more efficient. Mr. Hull. Will it replace any personnel who are now doing what it will do automatically ? Dr. Cummings. The design that the contractor has been asked to deliver calls for an operational system that can be run by the ex- isting number of personnel within our staff. Thus, there will be no more and no fewer personnel involved. Mr. Hull. Mr. Michel. FOREIGN USER FEE Mr. Michel. You mentioned the fee being charged for foreign in- stitutions that might be making inquiry ? Dr. Cummings. Yes, sir. Mr. Michel. I support that. I think it is wise. Is it based currently pretty much on a pay-as-you-go basis; are the fees commensurate with the service, or are we still subsidizing it? Dr. Cummings. In the area of interlibrary lending, the $2 fee we be- lieve will essentially cover all of the library handling and mailing costs. There will be no subsidy of that service. We have made similar calculations for the lending of our audio- visual materials. Here it is estimated now that we will charge $10 for the lending of films abroad. Unfortunately films are heavy and bulky and a good part of that will be for postage. We have not as yet arrived at a fee schedule for our computer searches abroad, and I would think in this case, Mr. Michel, we will probably have to subsidize the cost of some of the com- puter services that are done, particularly for the less developed countries. AMOUNT OF SERVICE PROVIDED TO FOREIGN COUNTRIES Mr. Michel. How many inquiries do you get a year in this area you are talking about ? Dr. Cummings. Last year would not be a fair representation to cite because we were forced to stop foreign services, but in the pre- vious year we made 25,000 loans abroad and of that number, about half went to South American countries.0410415_000012.txt

Page  12 1334 The number of film loans abroad was much less and I will ask Mr. Russell to correct my figures now or for the record if I am wrong. I believe there were a little more than 1,400. The number of computer services that we provided for foreign phy- sicians and scientists was about 500 on an annual basis. Mr. Michel. How do you account for that great number coming from South America ? Dr. Cummings. I wish I really knew the answer. I think that this represents the thirst for American medical information from our most immediate neighbors in the Western Hemisphere. Looking at this retrospectively it has persisted over about a 5-year period. I think some of the transference of American medicine to South America through our training of their doctors and scientists is being reflected now and they are seeking to stay abreast of new information. That is my guess. I cannot assure you that it is the only reason. Mr. Michel. When you say that last year was not a good year for measurement, there must be some reason ? Dr. Cummings. We stopped giving services last year. Mr. Michel. That was a budgetary determination? Dr. Cummings. That was a difficult decision that I made, with the advice of my Board of Regents, because of our limited manpower, not just dollars. We just didn't have enough manpower, and therefore we curtailed foreign services to all except those countries covered by our agreement with the Agency for International Development. RELATIONSHIP OF MEDLARS TO MEDICAL SCHOOLS Mr. Michel. Is MEDLARS tied with any of our medical schools? Dr. Cummings. Yes, sir. Mr. Michel. How many ? Dr. Cummings. We now have MEDLARS centers in eight American medical schools or medical centers. Mr. Michel. The optimum, of course, would have them all tied in, would it not, or is that oeyond reason ? Dr. Cummings. We have come to the point now where we believe that not every medical center or medical school in our country needs to be tied to the National Library of Medicine. REGIONAL MEDICAL LIBRARY PROGRAM What we are now trying to develop is a strategy to have satellite libraries linked to the regional libraries and we thmk that is the most efficient way. It cuts the line costs, charges for calls, cables, and the the like. That is the plan we are proceeding with. Mr. Michel. You have how many of these regions now ? Dr. Cummings. At the end of this fiscal year we will have 10 regions operational. Eight are fully activated now and awards have been made to two new regions. That will fully implement the program we presented to this committee 2 years ago. Mr. Michel. Now these 10 competing grants that will be extended. Is money in here to fund the on-going ones, even though there is none m here for new ones? What are these specially for?0410415_000013.txt

Page  13 1335 Dr. Cummings. The size of the grant ? Mr. Michel. And specially what do they do? Dr. Cummings. The 10 institutions that have regional library grants will receive in the aggregate about $2 million. So each regional library has on the average a grant of $200,000 a year to give library services broadly, lending services, reference services, bibliographic services, consultation services, to all of the health institutions within that region. I might say that a region is usually made up of five or six States and the regions are reasonably well balanced with regard to the num- ber of health professionals in each region. Mr. Michel. Do the 10 regions have any relationship to the regional offices of HEW? Dr. Cummings. No, they do not. location of regional libraries Mr. Michel. I got the erroneous impression they did. Why don't we have those particular regions described here in some fashion? Dr. Cummings. We can provide for the record a description giving the location and the region. (The information follows:)0410415_000014.txt

Page  14 REGION 10 ALASKA REGIONAL MEDICAL LIBRARY AND MEDLARS SERVICES REGION 11 HAWAII □ RML • MEDLARS CENTER 00 00 Oi0410415_000015.txt

Page  15 1337 DESCRIPTION OF REGIONAL MEDICAL LIBRARY LOCATIONS AND SERVICE AREAS Region and Grant Number I. New England 5 G04 LM 001*76-03 II. New York 1 G04 LM 00555-01 III. Mid-Eastern 5 G04 LM 00556-02 IV. Mid-Atlantic V. East Central 5 G04 LM 00628-02 VI. Southeastern 1 G04 LM 00717-01 VII. Midwest 5 GOU LM 00615-02 VIII. Mid-Continental 1 G04 LM 00862-01 IX. South Central 1 G04 LM 00785-01 X. Pacific Northwest 5 G04 LM 00554-02 XI. Pacific Southwest 1 G04 LM 00718-01 Library Francis A. Countway Library of Medicine 10 Shattuck Street Boston, Massachusetts 02115 The New York Academy of Medicine 2 East 103rd Street New York, New York 10029 Library of the College of Physicians of Philadelphia 19 South 22nd Street Philadelphia, Pa. 19103 NLM Wayne State University Medical Library 6U5 Mullett Street Detroit, Michigan U8226 A. W. Calhoun Medical Library Woodruff Research Bldg. Emory University Atlanta, Georgia 30322 The John Crerar Library 35 West 33rd Street Chicago, Illinois 60616 University of Nebraska Medical Center 42nd and Dewey Avenue Omaha, Nebraska 68105 Service Area Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont New York and 11 counties of Northern New Jersey Pennsylvania, Delaware and ten counties of southern New Jersey Virginia, West Virginia, Maryland, Washington, D.C. North Carolina Kentucky, Michigan, Ohio Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, Puerto Rico Illinois, Indiana, Iowa, Minnesota, Wisconsin and North Dakota Missouri, Kansas, Nebraska, Colorado, Wyoming, South Dakota, Utah University of Texas, Southwestern Arkansas, Louisiana, New Medical School at Dallas Mexico, Oklahoma, Texas 5323 Harry Hines Blvd. Dallas, Texas 75235 University of Washington Health Sciences Library Seattle, Washington 98l0b U.C.L.A. Biomedical Library The Center for the Health Sciences Los Angeles, California 90024 Alaska, Idaho, Montana, Oregon, Washington Arizona, California, Hawaii, Nevada0410415_000016.txt

Page  16 1338 CONTRACT BUDGET Mr. Michel. How much do we have in this budget for contracts? Dr. Cummings. The contract budget for 1971 is $3,047,000. Mr. Michel. Going principally for what ? Dr. Cummings. Going principally for the completion of our MED- LARS II system which is being developed for us under contract. Mr. Michel. Who is building it ? Dr. Cummings. Computer Sciences Corp. won the award for this task. Mr. Michel. They are located where ? Dr. Cummings. They are located in Santa Monica, Calif. They are one of the Nation's very large software companies. I might say, Mr. Michel, this is a unique contract in which we have a cost-sharing arrangement, and any over-runs which accrue will re- duce the fee of the contractor. We have found this a very interesting arrangement to have with the contractor. It has forced a very intense effort on their part and I might say the slippages to date, although reasonable, are beginning to show in their loss of fee. Mr. Michel. Maybe we ought to get that word out to a few other spots. Dr. Cummings. I am pleased to say my colleagues in the NIH have become very much interested in this contract methodology and are studying it with a possible view of applying it in other areas. Mr. Michel. You said principally. Is there any other area ? Dr. Cummings. Yes, sir, we have contracts which provide what I call brute force operations that relate to our computer system where we cannot perform the duties in-house. For example, much of our keypunching is done through contract for input into our system. The cost of doing this externally we have calculated to be lower than we could perform in-house. We have several contracts for support of MEDLARS centers in various institutions and we support our Lister Hill Center activities through contracts rather than through grants. These involve network building, use of telephone lines, on-line computer activities and the like. I should report also, that we use the contract mechanism for the ac- quisition of indexing input in foreign languages, such as Japanese and Russian. These are the major contractual areas. PUBLIC LAW 480 FUNDS Mr. Michel. Do you do any of this translating at all through Public Law 480 funds? Dr. Cummings. Yes, sir; wherever we can find scientific and lin- guistic competence abroad we use Public Law 480 funds. Notably this has been done in Israel with great success for our program and it pro- vides great economy as well. Mr. Hull. Mrs. Reid?0410415_000017.txt

Page  17 1339 agreement with aid Mrs. Reid. What is covered by the agreement between the National Library of Medicine and the Agency for International Development regarding services outside of the United States? Dr. Cummings. Under the AID/NLM Agreement the Library re- sponds to the needs of AID/Washington, AID/Missions and medical institutions and individuals in participating countries. The NLM services include interlibrary loans, reference services, MEDLARS de- mand searches and subscriptions to some of our publications. These, then are unique resources available to developing countries under this arrangement. The subject coverage relates to all aspects of health pro- grams including practice, education, research, and encompasses, for example, fields such as nutrition, population, and communicable dis- eases. Mrs. Reid. That is all, Mr. Chairman. Mr. Hull. Thank you, Doctor.0410415_000018.txt

Page  18 1340 Justification of the Budget Estimates DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE NATIONAL INSTITUTES OF HEALTH National Library of Medicine Amounts Available for Obligation 1970 1971 Appropriation................................ $19,682,000 $19,769,000 Unobligated balance brought forward.......... 700,000 --- Real transfers to: "Health Manpower".......................... -10,000 --- "Office of the Director"................... -20,000 --- "Operating Expenses, Public Building Services" General Services Administration.......... -79,321 --- Cutback to comply with Section 410 of 1970 Labor-HEW Bill.............................. -310,000_______--- Total obligations......................... 19,962,679 19,769,000 Disposition of cutback: To be returned to the Treasury............. 310,000 Total cutback........................... 310,0000410415_000019.txt

Page  19 1341 Obligations by Activity Page 1970 1971 Estimate Estimate Increase or Decrease Ref. Pos. Amount Pos. Amount Pos. Amount Grants: 138 Training.............. —- $983,000 --- $983,000 --- Special scientific 138 projects........... -- 5,000 -- 5,000 --- -- 139 Research.............. -- 990,000 -- 590,000 --- -400,000 140 Library resources..... -- 2,105,000 -- 2,105,000 -- -- Regional medical 140 libraries.......... --- 1,807,000 —- 1,842,000 —- +35,000 141 Publications support.. -- 267,000 -- 267,000 -- -- Subtotal.............. —- 6,157,000 --- 5,792,000 ---' -365,000 Direct operations: Lister Hill National Center for Biomed- 142 ical Communications. 10 898,000 10 906,000 National Medical 144 Audiovisual Center.. 105 2,049,679 105 1,799,000 145 Library operations___ 247 7,160,000 247 7,592,000 147 Toxicology information 18 1,507,000 18 1,185,000 Review and approval of 149 grants.............. 32 604,000 32 623,000 149 Program direction..... 55 1,587,000 55 1,872,000 Subtotal.............. 467 13,805,679 467 13,977,000 Total obligations..... 467 19,962,679 467 19,769,000 +8,000 -250,679 +432,000 -322,000 +19,000 +285,000 +171,321 -193,6790410415_000020.txt

Page  20 1342 Obligations by Object 1970 Estimate 1971 Estimate Increase or Decrease Total number of permanent positions.... 467 Full-time equivalent of all other positions...................... 18 Average number of all employees........ 485 Personnel compensation: Permanent positions.................. $5,424,000 Positions other than permanent....... 155,000 Other personnel compensation......... 89 ,000 Subtotal, personnel compensation.. 5,668,000 Personnel benefits..................... 451,000 Travel and transportation of persons... 167,000 Transportation of things............... 33,000 Rent, communications, and utilities.... 1,509,679 Printing and reproduction.............. 403,000 Other services: Project contracts.................... 3,382,000 Payment to NIH Management Fund....... 560,000 Other................................ 911,000 Supplies and materials................. 333,000 Equipment.............................. 388,000 Grants, subsidies and contributions.... 6,157,000 Total obligations by object.......... 19,962,679 467 18 485 $5,658,000 $+234,000 158,000 + 3,000 89,000 5,905,000 468,000 167,000 33,000 1,704,000 468,000 3,047,000 809,000 768,000 245,000 363,000 5,792,000 +237,000 + 17,000 +194,321 + 65,000 -335,000 +249,000 -143,000 - 88,000 - 25,000 -365,000 19,769,000 -193,6790410415_000021.txt

Page  21 1343 Summary of Changes 1970 estimated obligations....................................... $19 952 679 1971 estimated obligations....................................... 19 769 00O Net change.................................................. -193,679 \. Increases: Base Change from Base Pos. Amount Pos. Amount 1. Built-in a. Annualization of 1970 pay increase... -- -- __ $+19,000 b. Within grade pay increase............ -- -- __ +235 000 c. FTS cost increase .1.................. --- --- --- +3 000 Subtotal............................. — --- --- +257,000 2. Program a. Regional medical library grants...... --$1,807,000 -- +35,000 b. Library operations................... -- 7,160,000 -- +300,000 Subtotal............................. -- -- ... +335,000 3. Payment to "National Institutes of Health Management Fund" for centrally furnished services..................... -- 560,000 -- +249,000 Total increases........................ -- -- __ +841,000 i. Decreases: 1. Program a. Research grants...................... -- 990,000 -- -400,000 b. National Medical Audiovisual Center.. -- 2,049,679 -- -299,679 c. Toxicology information............... -- 1,507,000 -- -335,000 Total decreases...................... --- --- --- -1,034,679 Net change......................... --- --- --- -193,679 45-517—70—J>t. 3----850410415_000022.txt

Page  22 1344 Explanation of Changes Built-in Increases -- These increases will provide: $19,000 for the annual- ization of the 1970 pay increase authorized by the Federal Salary Act of 1967 and Executive Order 11474; $235,000 for within grade pay increases in 1971; and $3,000 for increased cost in 1971 of using the Federal Tele- communications System. Regional medical library grants -- An increase of $35,000 will bring the total for this program to $1,842,000. The 1971 amount will fund continuation of the ten existing regional medical libraries. Library operations -- An increase of $300,000 will provide for continued development and installation of the MEDLARS II computer system. MEDLARS II will provide the computer file capacity necessary to keep abreast of the expanding volume of medical literature and increasing service demand. Research grants -- A decrease of $400,000 will bring the total for this pro- gram to $590,000. The 1971 amount will fund 17 continuation grants to support the investigation and development of new techniques in health information communication. National Medical Audiovisual Center -- A total of $1,799,000 and 105 positions is requested in 1971, a program decrease of $299,679. The decrease occurs in the audiovisual production program and coincides with a shift in empha- sis away from production toward improved audiovisual loan services. Toxicology information -- A total of $1,185,000 and 18 positions is requested in 1971, a program decrease of $335,000. The decrease represents a plan- ned reduction in project contracts to make funds available to support con- tinuation of the ten active regional rredical libraries. Authorizing Legislation 1971 Legislation Public Health Service Act Section 371 - Purpose and Establishment of Library............. Section 394 - Grants for Training in Medical Library Sciences.......... Section 395(a) - Assistance for Special Scientific Projects.......... Section 395(b) - Assistance for Research and Development in Medical Library Science and Related Fields....................... Section 396 - Grants for Establishing, Expanding, and Improving the Basic Resources of Medical Libraries and Related Instrumentalities............ Section 397 - Grants for Establishment of Regional Medical Libraries........ Section 398 - Financial Support of Bio- medical Scientific Publications...... Authorization Requested Indefinite $1,500,000 500,000 3,000,000 3,500,000 3,000,000 1,000,000 Appropriation Requested $13,977,000 983,000 5,000 590,000 2,105,000 1,842,000 267,0000410415_000023.txt

Page  23 1345 PUBLIC HEALTH SERVICE ACT Part H—National Library of Medicine Purpose and Establishment of Library Section 371. In order to assist the advancement of medical and related sciences, and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health, there is hereby established in the Public Health Service a National Library of Medicine___ ' Part J—Assistance to Medical Libraries Section 394(a). In order to enable the Secretary to carry out the pur- poses of section 390(b)(2), there are authorized to be appropriated $1,500,000 for the fiscal year ending June 30, 1971, $1,750,000 for the fiscal year ending June 30, 1972, and $2,000,000 for the fiscal year end- ing June 30, 1973. Sums made available under this section shall be uti- lized by the Secretary in making grants— (1) to individuals to enable them to accept traineeships and fellowships leading to postbaccalaureate academic degrees in the field of medical li- brary science, in related fields pertaining to sciences related to health, or in the field of the communication of information; (2) to individuals who are librarians or specialists in information on sciences relating to health, to enable them to undergo intensive training or retraining so as to attain greater competence in their occupations (in- cluding competence in the fields of automatic data processing and retrieval); (3) to assit appropriate public and private nonprofit institutions in developing, expanding, and improving, training programs in library science and the field of communications of information pertaining to sciences re- lating to health; and (4) to assist in the establishment of internship programs in established medical libraries meeting standards which the Secretary shall prescribe. Section 395. (a) In order to enable the Secretary to carry out the pur- poses of section 390(b)(3), there are hereby authorized to be appropriated for each fiscal year, beginning with the fiscal year ending June 30, 1966, and ending with the fiscal year ending June 30, 1973, such sums, not to exceed $500,000 for any fiscal year, as may be necessary. Sums made avail- able under this subsection shall be utilized by the Secretary to make grants to physicians and other practitioners in the sciences related to health, to scientists, and public or nonprofit private institutions on behalf of such physicians, other practitioners, and scientists for the compilation of ex- isting, or writing of original, contributions relating to scientific, social, or cultural, advancements in sciences related to health. In making such grants, the Secretary shall make appropriate arrangements whereby the facil- ities of the National Library of Medicine and the facilities of libraries of public and private nonprofit institutions of higher learning may be made available in connection with the projects for which such grants are made. (b) In order to enable the Secretary to carry out the purposes of section 390(b)(4), there are hereby authorized to be appropriated for each fiscal year, beginning with the fiscal year ending June 30, 1966, and ending with the fiscal year ending June 30, 1973, such sums, not to exceed $3,000,000 for any fiscal year, as may be necessary. Sums made available under this subsection shall be utilized by the Secretary in making grants to appro- priate public or private nonprofit institutions and entering into contracts with appropriate persons, for purposes of carrying out projects of research, investigations, and demonstrations in the field of medical library science and related activities and for the development of new techniques, systems and equipment, for processing, storing, retrieving, and distributing infor- mation pertaining to sciences related to health. Section 396. (a) In order to enable the Secretary to carry out the pur- poses of section 390(b)(5), there are authorized to be appropriated $3,500,000 for the fiscal year ending June 30, 1971, $4,000,000 for the fiscal year ending June 30, 1972, and $4,500,000 for the fiscal year end- ing June 30, 1973. (b) Sums made available under this section shall be utilized by the Sec- retary for making grants of money, materials, or both, to public or private nonprofit medical libraries and related scientific communication instru- mentalities for the purpose of establishing, expanding and improving their basic medical library or related resources.0410415_000024.txt

Page  24 1346 Section 397. (a) In order to enable the Secretary to carry out the pur- poses of section 390(b)(6), there are authorized to be appropriated $3,000,000 for the fiscal year ending June 30, 1971, $3,250,000 for the fiscal year ending June 30, 1972, and $3,500,000 for the fiscal year end- ing June 30, 1973. Sums made available under this section shall be uti- lized by the Secretary, with the advice of the Board, to make grants to existing public or private nonprofit medical libraries so as to enable each of them to serve as the regional medical library for the geograph- ical area in which it is located. Section 398. (a) In order to enable the Secretary to carry out the pur- poses of section 390(b)(7), there are hereby authorized to be appropriated for each fiscal year, beginning with the fiscal year ending June 30, 1966, and ending with the fiscal year ending June 30, 1973, such sums, not to exceed $1,000,000 for any fiscal year, as may be necessary. Sums made available under this section shall be utilized by the Secretary, with the advice of the Board, in making grants to, and entering into appropriate contracts with, public or private nonprofit institutions of higher edu- cation and individual scientists for the purpose of supporting biomedical scientific publications of a nonprofit nature and to procure the compil- ation, writing, editing, and publication of reviews, abstracts, indices, handbooks, bibliographies, and related matter pertaining to scientific works and scientific developments. Section 399. Funds appropriated to carry out any of the purposes of this part for any fiscal year shall remain available for such purposes for the fiscal year immediately following the fiscal year for which they were appropriated.0410415_000025.txt

Page  25 1347 Explanation of Transfers Proposed transfer to: "Office of the Director" 1970 Estimate $20,000 Purpose To provide funds for additional support in the Office of the Director, NIH. 'Health Manpower" 10,000 To provide funds for support of position related to transfer of Construction Grant Program to "Construction of Health, Educational Research, and Library Facilities. "Operating Expenses, Public Building Service" General Services Adminis- tration 79,321 Transfer of rental costs associated with the Nation- al Medical Audiovisual Center film distribution activity in Atlanta, Georgia. National Library of Medicine Diiu^ei. Estimate House Senate Year to Congress Allowance Allowance Appropriation 1961 $ 1,738,000 $ 1,738,000 $ 1,738,000 $ 1,738,000 1962 2,066,000 2,066,000 2,066,000 2,066,000 1963 3,335,000 3,335,000 3,335,000 3,335,000 1964 4,074,000 4,074,000 4,074,000 4,074,000 1965 3,678,000 3,858,000 4,058,000 3,958,000 1966 9,185,000 9,185,000 9,685,000 9,685,000 1967 19,231,000 20,092,000 20,192,000 20,192,000 1968 21,162,000 18,662,000 21,162,000 19,912,000 1969 19,172,000 17,149,000 19,172,000 18,160,500 1970 22,182,000 19,682,000 19,682,000 19,682,000 1971 19,769,000 0410415_000026.txt

Page  26 1348 Justification National Library of Medicine 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits......... 467 $6,119,000 467 $6,373,000 — +$254,000 Other expenses Budget authority:.... - 13,143.679 - 13.396,000 - + 252,321 Subtotal.......... 467 19,262,679 467 19,769,000 — +506,321 Brought forward:..... 700.000 __________......700,000 Total obligations. 467 19,962,679 467 19,769,000 — -193,679 General Statement The National Library of Medicine has a Congressional mandate to apply its resources broadly to advance the medical and health-related sciences. The Li- brary collects, organizes and makes available biomedical information to prac- titioners, educators, and investigators, and carries out programs designed to strengthen existing and develop new medical library services in the United States. Through the Medical Library Assistance Act of 1965, the National Library of Medicine has supported the strengthening of biomedical libraries and related institutions to support health care, the development of more effective relation- ships, improvement of information handling techniques, and the enhancement of the role of libraries as learning resources. Other achievements include the further development of the computer based Medical Literature Analysis and Retrieval System (MEDLARS) and the initial efforts in the development of a Toxicology Information Program. At the same time Lhe NLM has provided direct bibliographic and interlibrary loan services to thousands of users. The NLM embarked in 1967 on a long-range plan to develop and implement a national multimedia communications network utilizing advanced information sci- ence technology to bring biomedical information to physicians and other health professionals. This effort was formally recognized in August 1968 when the Secretary, Department of Health, Education, and Welfare, on passage of Public Law 90-456, established the Lister Hill National Center for Biomedical Commu- nications within the National Library of Medicine responsible for the design, implementation, and management of the biomedical communications network. Tech- nical management planning has been completed. Substance of the program is now being planned in cooperation with professional organizations. The 1971 budget request includes funds in all categories of support autho- rized by the proposed extension of the Medical Library Assistance Act (with the exception of Medical Library Construction) to continue the development and sup- port of the Nation's biomedical information resources.0410415_000027.txt

Page  27 1349 GRANTS The programs authorized by the Medical Library Assistance Act of 1965 (Public Law 89-291) and the proposed extension and amendments are designed to meet national needs for better health information services through improved health library resources and facilities, trained manpower, and improved health communications technology. Specifically, the Act authorizes support of pro- jects to develop facilities and techniques necessary to collect, preserve store, process, retrieve, and facilitate the dissemination and use of health science information. Training and fellowships Non-competing continuation grants................... New grants................. Total................ 1970 Estimate No. of Awards Amount 1971 Estimate No. of Awards Amount Increase or Decrease No. of Awards Amou $397,000 586,000 10 $983,000 11 983,000 10 983,000 +4 +$586,000 -5 - 586,000 The 1971 request for training is tha same as 1970. This will allow the Library to support ten nor.-competing continuation grants but no new grants will be supported in 1971. Current estimates indicate that each of 100 medical schools require an average of 10 professionally trained staff and approximately 1,000 other health related professional schools each require at least one librarian. In addition, the 7,200 accredited hospitals need a hospital librarian or other medical in- formation specialist. Currently there are about 1,400 professionally trained medical librarians available in these institutions. Or. the basis of the above figures it is estimated that there is a need for up to 8,200 trained medical librarians and other health communications specialists. In 1969 and 1970, the National Library of Medicine assisted the support of 90 trainees. Since the fiscal authorization for 'raining cannot provide fulfillment of the estimated total professional medical librarian manpower requirement, the program emphasizes training persons for creative leadership in positions of major responsibility. Special Scientific Projects 1970 Estimate 1971 Estimate Increase or Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amounr Non-'-omppt i-r6 continuation grants................... New grants................. Total................ $5,CC0 1 $5,000 5,000 5,0000410415_000028.txt

Page  28 1350 The 1971 request of $5,000 for special scientific project grants repre- sents a continuation of the 1970 level of support, i.e., one non-competing continuation grant. The purpose and intent of the Special Scientific Project Awards program is to support outstanding scholars who can devote their full time to analysis, evaluation and documentation of major advances in the health sciences. These studies result in the publication of important monographs on advances in medi- cine. Research 1970 1971 Increase or Estimate Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Budget Authority: Non-competing continuation grants................... 12 $364,000 17 $590,000 +5 +$226,000 New grants................. 8 226,000 ______™______-8 - 226,000 Subtotal............... 20 590,000 17 590,000 -3 Brought forward: Non-competing continuation grants................... 12 400,000 ______ -12 - 400,000 Total obligations...... 32 990,000 17 590,000 -15 -400,000 The 1971 request is for $590,000 in new obligational authority. This re- presents a decrease of $400,000 from the 1970 level of $990,000. This amount will allow the Library to support 17 non-competing continuation grants. No new projects will be supported. The continuing high level of national effort in health service, education and research produces and requires a constantly growing amount of biomedical information. Knowledge leading to more effective transmission, storage, and retrieval of this information at realistic cost-benefit ratios is an important goal of biomedical information research. Projects will be support in areas such as: (1) information seeking practices of health professionals; (2) im- provement of biomedical vocabulary for written and mechanized information han- dling; (3) improved information systems; and (4) development and testing of various information media. Demonstration projects are needed to show how the findings of research can benefit information services under actual operating conditions. The Extramural Program supports a variety of studies in these areas. The national problem of biomedical communications has aroused the attention of the health community and institutions and individuals outside the health field who are capable of and interested in developing solutions. Many of the investi- gations require support over a long term as project design leads to data accu- mulation, experimentation, and evaluation. The need for increased support levels will continue, particularly when definitive testing of methods or equip- ment is involved, and when demonstration projects progress from the planning to the operational stage.0410415_000029.txt

Page  29 1351 Library Resources 1970 1971 Increase or Estimate Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Non-competing continuation grants................... 389 $2,017,000 398 $2,105,000 +9 +$88,000 New grants................. 12________88,000 ________ -12 - 88,000 Total................. 401 2,105,000 398 2,105,000 -3 The 1971 request of $2,105,000 for library resources grants provides the same level of support as in 1970. This will allow the Library to support the 398 non-competing continuation grants in hospitals and health professional educational institutions. No new projects are anticipated. The program as structured in the Medical Library Assistance Act of 1965 provides financial assistance and incentive for improving the basic materials, equipment, and services of medical libraries. The amount of each resource grant under this legislative authority is computed by a formula based on the annual operating budget of the library. A library receiving an initial award may request continued support for subsequent years in decreasing amounts. The amendments to this program imposed in 1969 will allow a shift from the structured less flexible system of formula based grants to a system which will encourage innovative plans for new and expanded services to users. This program is vital and essential for the immediate and rapid improve- ment of the several hundred medical libraries supported by hospitals, educa- tional institutions, and medical societies. These libraries are major stations and links in the development and operation of a national biomedical communi- cations network. Regional Medical Libraries 1970 1971 Increase or Estimate Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Budget Authority: Non-competing continuation grants................... 6 $1,004,000 10 $1,842,000 +4 +$838,000 New grants................. 2 503,000 —_______ -2 - 503,000 Subtotal............... 8 1,507,000 10 1,842,000 +2 +335,000 Brought forward:.............. Non-competing continuation grants................... 2 300,000 —_______ -2 - 300,000 Total obligations...... 10 1,807,000 10 1,842,000 -- + 35,000 The 1971 request for $1,842,000 represents an increase of $35,000 over the 1970 level. This amount will allow the library to maintain the support of the ten active regional libraries. The objective of this program is to develop a system of Regional Medical Libraries with the necessary depth and scope to supplement the services of other medical libraries in their designated region. Back-up services to local libraries include interlibrary loans, MEDLARS literature searches, and other reference services to user organizations and institutions. The Regional Medi-0410415_000030.txt

Page  30 1352 cal Library system increases and equalizes the availability of medical liter- ature to users in the region. It is of particular benefit to those practi- tioners who do not have access to a major medical library. Grants are awarded to improve, augment, and strengthen regional service in libraries selected because they already have a sound base for providing ex- panded services in the region. In 1967 the first Regional Library grant was made to Countway Medical Library of Harvard University. This enabled the acti- vation of the New England regional medical library system. In 1968 Regional Libraries were established in Seattle and Philadelphia; in 1969, in Los Angeles, New York, Detroit, Chicago, and Atlanta. Regional Libraries will be established in 1970 in Texas and Nebraska to complete the geographic coverage required for the United States. Publications Support 1970 1971 Increase or Estimate Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Non-competing continuation grants................... 8 $224,000 10 $267,000 +2 +$43,000 New grants................. __2______43,000 _______-^_______-2 - 43,000 Total................. 10 267,000 10 267,000 The 1971 request of $267,000 for publications support grants is the same as 1970. This will allow the Library to support ten continuing projects. No new projects are anticipated. The purpose of this program is to assist in the development of useful, selected publications required by American health professionals to digest and utilize the tremendous output of new information in the biomedical sciences. Support is provided for the preparation and/or publication of secondary tools (such as abstracts, bibliographies, handbooks, and critical reviews, as well as monographs and translations) which condense, synthesize, evaluate, or other- wise repackage information for health scientists, educators, and practitioners. Among the projects requiring support are reviews of recent research on environmental health and substances toxic to man; assistance for a new period- ical to provide needed information on nutrition-education to field workers in high incidence areas of malnutrition, the development of a manual of community medicine for use by physicians in remote or relatively under-developed regions, and experimental or innovative publications to improve and promote self-instruc- tion by medical students. Current trends indicate continued and increased need for the secondary publications supported under this program to meet the challenge of the increas- ing output of new knowledge on health and disease, due to the rapid develop- ment of special areas (such as environmental pollution and organ transplanta- tion), the continued growth of established areas (such as anti-tumor drugs, mental health) and the growth of multi-disciplinary research.0410415_000031.txt

Page  31 1353 DIRECT OPERATIONS 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits......... 467 $6,119,000 467 $6,373,000 -- +$254,000 Other expenses.......... 7,686,679 -- 7,604,000 -- - 82,679 Total................ 467 13,805,679 467 13,977,000 — +171,321 Lister Hill National Center for Biomedical Communications 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation 10 $238,000 660,000 10 $246,000 660,000 __ +$8,000 Other expenses.......... -- 10 898,000 10 906,000 -- + 8 000 The Lister Hill National Center for Biomedical Communications was estab- lished as the Department of Health, Education, and Welfare focal point for the coordination of biomedical communications systems and network projects within the Department. It also serves as the Departmental representative with other Federal agencies and private organizations. The Center applies technology to the development of biomedical communications systems aimed at improving medical education, medical research, and the delivery of health services. One of its specific responsibilities is the design, development, implementation, and tech- nical management of a Biomedical Communications Network. The Center has commenced the detailed design of an experiment to introduce interactive computer-aided problem-solving into undergraduate, graduate, con- tinuing medical education, and into the delivery of information for better health care. The experiment, centered on the University of Vermont's computer- based problem-oriented medical record system, will involve the University of Vermont Medical School, Dartmouth Medical School; the state medical societies of Vermont and New Hampshire, the Regional Medical Program, several hospitals and private practitioners. Experimental network services should be started in early 1971. The Lister Hill Center is currently planning and determining costs of several experimental national information or communications services to support medical education or aid the delivery of health care. The Center has completed plans for an experiment in the use of teletypewriter terminals and TWX lines to access bibliographic citations to current medical literature stored in an on- line time-sharing computer. The capability being demonstrated will allow users to access the literature from the top leading 100 medical care journals for the cost of a telephone call.0410415_000032.txt

Page  32 1354 The Center is assisting several medical schools in the planning and pilot implementation of medical conference and consultative services using the satellite communications technologies and equipment developed and supplied by the National Aeronautics and Space Administration (NASA). The Center is cooperating with NASA, the University of Wisconsin, and Stanford University to develop technical experiments which would permit medical audio consultation between remote areas of Alaska and the Pacific Basin, and the medical centers at Stanford University, University of Wisconsin, and the National Institutes of Health. The Center has installed an experimental satellite communications terminal on the NIH campus as a part of this effort. Experimental network consultative services will be initiated when the customer groups are ready. The Center has an on-going effort with the Association of American Medi- cal Colleges (AAMC), to study the difficult problem of content selection, pro- duction, and evaluation for medical schools. The AAMC effort is being aug- mented by technical inputs and content guidance provided by a highly quali- fied group of medical educators. The guidance coming from this project will assist in the proper design of network services to support medical schools. A strong effort is being pursued in the area of individualized education aimed at allowing medical students and practicing physicians to learn at their own pace. A prototype individualized biomedical communications module has been developed by the Center. The module provides a multi-media educational capability with a cassette tape-recorder, microfiche-microfilm viewer and slide projector for aural and visual learning all contained in a briefcase. A small number of the modules are currently being evaluated by the Center and selected users. The Center, in conjunction with the American Medical Association, has met with groups in Washington, Oregon, and Alaska to commence the identific- ation of the most profitable areas for communications support of medical education with the community hospital or the academic medical center as the focal point. The Center is also working very closely with medical groups in the Central United States which are interested in developing effective methods of interconnecting medical facilities and focusing resources on improved medi- cal education and health care. In 1968, the Lister Hill Center initiated work on an inventory of bio- medical communications projects in the Department of Health, Education, and Welfare. A prototype Biomedical Communications Inventory (BCI) was published during early 1969 and distributed within the health agencies of the Department. Efforts are underway to update and expand the BCI into a useful resource for the coordination and planning of Departmental communications and information systems. The Center is sponsoring a project for the development of remote on-line vocabulary building and search services to support NLM's indexing function. The project involves the use of cathode ray tubes, and interactive terminals for handling Medical Subject Headings and Auxiliary Chemical Module indexing and searching activities.0410415_000033.txt

Page  33 1355 The 1971 request is $906,000 and ten positions. This is a net increase of $8,000, consisting of $1,000 for annualization of the 1970 pay increase, and $7,000 for within-grade pay increases. In 1971, the Center will conduct experimental network activities to support medical education, medical research, and health care services. Other activities include efforts to select and eval- uate content for medical education, to develop sharing of such materials among medical colleges and avoid duplicative production. Such efforts will make needed services available to larger audiences and avoid competing developments. National Medical Audiovisual Center 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits......... 105 $1,291,000 105 $1,340,000 -- +$49,000 Other expenses.......... _zz_______758,679 _______459,000 -- -299,679 Total................ 105 2,049,617 105 1,799,000 -- -250,679 The National Medical Audiovisual Center constitutes a central facility for the production, distribution, and promotion of the use of audiovisual media in biomedicine. The Center which is located in Atlanta, Georgia, was formerly a component of the Communicable Disease Center. An organizational transfer placed the Center under the National Library of Medicine in 1968. In September 1969 the Board of Regents of the National Library of Medicine recommended a realignment of priorities in the Center's activities. The Board has recognized that audiovisual materials in the hoalth fields have been under- utilized for instructional purposes for lack of an adequate acquisition, cata- loging and distribution capability. More than half of NMAC's operations were concerned with the production of audiovisual materials. Private industry, uni- versities, and health related organizations are producing medical audiovisuals in increasingly larger numbers. The emphasis on the Center's activities in 1970 and 1971 will shift away from the production of conventional motion pic- tures and other audiovisuals, and move toward the provision of improved loan and reference services from the unique collection of NMAC, probably the most comprehensive in the world. The Center will concentrate on collecting and cataloging quality films and tapes and on making these available to qualified users. Ultimately it is intended to support the distribution function on a fee for service basis which partially recovers costs for this operation through a public enterprise revolving fund. This will require new legislation. In 1971 the production activity of NMAC will be reorganized to stress innovation. The educational and technical assistance services will be ex- panded to support the needs of the schools of the health professions and practicing physicians. Services will include guidance in the selection of audiovisuals for specific curricula, types and uses of audiovisual media and equipment, and the planning and design of audiovisual facilities. Evaluation of new techniques and methodology for audiovisual use will become a more im- portant part of the program.0410415_000034.txt

Page  34 1356 The net decrease of $251,679 results from a program decrease of $299,679, offset by increases of $4,000 for annualization of 1970 pay increase and $45,000 for within-grade pay increases. The program reduction reflects the shift in emphasis away from production toward distribution. By 1971, pro- duction activities of NMAC will have been reduced to the level necessary to support enough technical competence to provide educational and technical con- sultation and to maintain archival and distribution functions. It is likely that continued conversion of the distribution activity to automated systems, and reorientation of the Center's focus toward acquisition and distribution will lead to greatly expanded and more efficient distribution services. Library Operations 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits......... 247 $3,108,000 247 $3,240,000 -- +$132,000 Other expenses.......... 4,052,000 -- 4,352,000 -- +300,000 Total................ 247 7,160,000 247 7,592,000 — +432,000 Library Operations provides bibliographic, reference, and loan services as a national backup for a network of regional and local medical libraries serving the Nation. More than 250,000 such services were provided in 1969 at the NLM in addition to those provided at regional libraries. Approximately 220,000 medical and health articles are indexed annually for inclusion in Index Medicus, the comprehensive monthly listing of citations to current world-wide literature. In 1970, 5,500 subscriptions to the monthly Index Medicus were sold by the Superintendent of Documents. The citations are stored in the computerized Medical Literature Analysis and Retrieval System (MEDLARS) and retrieved for publication of Index Medicus, Cumulated Index Medicus (an annual 10,000 page product) and 17 recurring bibliographies pre- pared for and supported by specialty groups in health professional fields such as medical education, dentistry, nursing, anesthesiology, neurosurgery, and epidemiology. These data are also used to provide 19,000 bibliographies upon demand by health professionals. Beginning in 1970 and of particular interest is the publication of an Abridged Index Medicus which contains information from 100 high quality English language journals, selected with particular reference to their orientation to patient care and the training of health manpower. The form is particularly suitable for small hospitals and individual health practitioners. The Library also provides services to individual health professionals. These include interlibrary loans, bibliographic searches (both traditional and computer-prepared), and the direct use of the collection.0410415_000035.txt

Page  35 1357 The Library has extended the resources of its collection and its computer data base to regional libraries and MEDLARS Centers so that these services are more responsive to need and are readily accessible throughout the country. In 1971 these services will be fully operational in 11 regions covering the entire United States including the Mid-Atlantic Region. In addition, the Library will provide management support to maintain and service this system and to service requests which cannot be satisfied within the regions. During 1971, a graphic image storage and retrieval system, containing microfilms of documents from publications in greatest demand, will become operational. With a capacity of about 200,000 documents this system will provide rapid and reliable document delivery for interlibrary loans on an automated basis. The Library provides resource support to the technical services of medi- cal libraries in the U.S. Its computer-generated Current Catalog provides announcement and cataloging information for medical libraries throughout the world. A recently developed computer-generated announcement service on a semi-weekly basis will be fully implemented by 1971. This greatly improved service will provide a cost savings to the Nation's libraries by reducing redundant cataloging. The request for Library Services in 1971 is $4,100,000 and 193 positions, an increase of $109,000 over the 1970 level. This increase includes $8,000 for annualization of the 1970 pay increase and $101,000 for within-grade pay increases. These funds will permit 125,000 interlibrary loans, 19,000 computer gen- erated demand searches, 86,000 reader requests filled (direct use of the col- lection), 230,000 articles indexed (an increase of 10,000), and 21 recurring bibliographies. The collection will be augmented by the addition of 94,000 serial pieces and 27,000 monographs and the Library will process other publi- cations. Maintenance of the collection will include the binding of 23,000 volumes and the preservation microfilming of 1,400,000 pages of deteriorating documents. Development and implementation of second-generation MEDLARS In 1968 the National Library of Medicine awarded a contract to Computer Sciences Corporation for the design and installation of a second-generation Medical Literature Analysis and Retrieval System (MEDLARS II) to replace the current system which was implemented during 1964. During the five years of operation of MEDLARS I, over 1,000,000 citations to medical literature were entered into the data base and a variety of unique services and publications were provided to the biomedical community. The size of the data base and demand for services required that the system be expanded in both size and flexibility of operation. The MEDLARS II plan called for a 3 to 4 year proj- ect of development and incremental upgrading. The systems design is complete and first-phase operations on the new equipment are scheduled to begin in 1970.0410415_000036.txt

Page  36 1358 When fully operational MEDLARS II will incorporate these technical elements: (1) increased processing capability; (2) use of internal on-line storage devices which will permit direct access to the data base; (3) multi-programming capa- bility which will permit several tasks to be performed by the computer simul- taneously; and, (4) limited on-line access to data bases from remote terminals. Translated into program capabilities, these new features will provide: (1) a greatly increased file capacity to allow the maintenance of abstracts and sum- maries and bibliographic citations on the data record; (2) faster response to an increasing volume of bibliographic service requests, including demand searches and recurring bibliographies; (3) the processing of more current data through direct input and on-line updating of the file; (4) an automated acquisition and cataloging system with cataloging data availability to and from other medical libraries; (5) development of specialized information services supporting the toxicology information and drug literature programs through the addition of chemical name and structure search capabilities in the new system; and, (6) support of data processing and data transmission activities of the biomedical communications network. Some of the hardware for MEDLARS II has been installed for operational evaluation, but it will be necessary to operate MEDLARS I in parallel with the new system for at least six months after implementation of the new system. After conversion to the new hardware, additional systems upgrading will con- tinue through the remainder of the year. The 1971 request includes $3,492,000 and 54 positions to operate the MEDLARS I system for six months and to continue development, implementation and follow-on operations of the MEDLARS II system. The 1971 request provides an increase of $323,000 over 1970 which includes $2,000 for annualization of the 1970 pay increase, $21,000 for within-grade pay increases, and $300,000 in program increases. The program increase of $300,000 provides $468,000 for MEDLARS II equipment, $125,000 in Linotron charges, and $18,000 for other ob- jects offset by a decrease of $311,000 in software support and other project contracts. Toxicology Information 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount 18 $309,000 18 $322,000 __ +$13,000 rj98,000 863,000 -- -335,000 18 1,507,000 18 1,185,000 -- -322,000 Personnel compensation and benefits........ Other expenses......... Total............... The Toxicology Information Program was established by Presidential Order. Responsibility for its implementation was delegated to the National Library of Medicine by the Secretary, Department of Health, Education, and Welfare. This program will provide access to existing information on the effects of a given chemical compound on biological organisms for physicians, scientists, educators nnd federal agencies. Toxicological data are currently scattered among numerous non-mechanized and uncoordinated information sources. The toxicology program is organizing toxicologic data to facilitate retrieval and provide information upon request through automated processing.0410415_000037.txt

Page  37 1359 $1 185 00"ana 18 Ll?^™ COmprises tw° general areas of effort for which from the 19?S level T™ ?! re"Uested in "71, a net decrease of $322,000 annualization of S' ,5 ' decrease consists of increases of $1,000 for «e«e. offset Jv - M«n^V inCre3Se ^ $12'°00 f°r "ithin-grade pay in- ta" suonort for th $? 5,0°° Pr°8ram dCCrease t0 make funds available to main- tain support for the ten regional medical libraries in 1971. Development and Operation of a Computer-Ba^d Toxicology Information System ■nrf flAchiev^ments ^"igh 1970 include: (1) development of registry numbers and approved names for about 30,000 chemicals; (2) consolidation of toxicity information on 700 - 1,000 chemicals; (3) development of storage/retrieval software; and (4) development of software and hardware for input/output of scientific and technical information in graphic and symbolic form. Developments during 1971 are aimed at improving the basic capabilities to handle a variety of scientific material as input to files for retrieval and dissemination. The elements to be retained in the structured files will be selected on the basis of current effort to selectively derive toxicology information from published sources. Decentralized usage experiments will be conducted in 1971 within a defined user community. Toxicology Information Products and Services Achievements through 1970 include: (1) standardization of authoritative terminologies through the convening of expert panels; (2) the Directory of Information Sources in the United States: General Toxicology published and made available for sale to the public through the U. S. Government Printing Office; (3) the Toxicity Bibliography which received broad acceptance by the public; (4) the computerized national roster of experts in toxicology has been tested and has become operational to assist in developing rapid response to toxicological problems as they arise; (5) a significant response rate to a User Study questionnaire which has provided a valuable tool to guide the devel- opment of new and improved products and services in toxicology and related fields; and, (6) effective liaison between TIP, industry, and the academic community established for the purpose of identifying resource centers in toxicology. Emphasis during 1971 will be directed to the introduction of new useful products and services to satisfy specific user needs, based upon guidance re- ceived from the National Academy of Sciences and evaluation of User Study re- sults. The areas of pesticides and environmental control agents will be stress- ed. The nationwide roster of 4,000 toxicology experts will be further refined for greater specificity in matching a clearly defined problem with the best qualified expert. A new review publication retrospectively covering the effects on human health resulting from the interaction of chemicals (drugs, environmental agents, food ingredients, etc.) will be supported. The identification, evaluation and recommendations of published and un- published sources of toxicological information for the development of new pro- ducts and services will be continued and updated. 45-517—70—pt. 3----8&0410415_000038.txt

Page  38 1360 Review and Approval of Grants Personnel compensation 1970 Estima Pos. 32 32 .te Amount $437,000 167,000 1971 Estimate Pos. Amount 32 $455,000 168,000 Incn Deci Pos. sase or rease Amount +$18,000 +1,000 604,000 32 623,000 -- + 19,000 This activity provides the administrative staff and program direction for the Medical Library Assistance grant activity and for international activities of the NLM funded by the Scientific Activities Overseas (Special Foreign Cur- rency) appropriation. The increase of $19,000 includes $1,000 for annualization of 1970 pay in- crease, $17,000 for within-grade pay increases, and $1,000 for payment to the National Institutes of Health Management Fund for centrally furnished services. Program Direction 1970 1971 Increase or Estimate Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits......... 55 $736,000 55 $770,000 — +$34,000 Other expenses.......... 851,000 — 1,102,000 -- +251,000 Total................ 55 1,587,000 55 1,872,000 -- +285,000 This activity supports the immediate Office of the Director, the Office of Administrative Management, and the Office of Public Information and Publi- cations Management. The increase of $285,000 includes $2,000 for annualization of the 1970 pay increase, $32,000 for within-grade pay increases, $3,000 for FTS cost increases, and $248,000 for payment to the National Institutes of Health Management Fund for centrally furnished services.