History of Medicine
Commentary by Dr. Martin M. Cummings on his testimony before the U.S. Senate Appropriations Subcommittee concerning the National Library of Medicine, for fiscal year 1966
From interviews with Dr. Cheryl Dee, 2009
Excerpts of U.S. Senate subcommittee testimony concerning the National Library of Medicine, followed by an interview with Dr. Martin M. Cummings, Director Emeritus, National Library of Medicine, reflecting upon the testimony
DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1966
TUESDAY, JULY 20, 1965
U.S. SENATE . . . Subcommittee of the Committee on Appropriations
Opening Statement of Dr. Martin M. Cummings, Director, National Library of Medicine
The task of indexing and storing the world's biomedical literature is centralized; however, the retrieval capability of MEDLARS can be shared by other libraries through decentralization. Decentralization of MEDLARS began in 1965 with the establishment of the demonstration center at the medical school of UCLA. Working with the basic MEDLARS data files and computer programs on magnetic tape, UCLA converted the data tapes and programs into computer language compatible with the locally available equipment that operated a search and retrieval service remote from the central NLM facility. A second center will be established at the University of Colorado.
MEDLARS is an acronym for Medical Literature Analysis and Retrieval System. The basic concept of MEDLARS is to utilize the computer as a massive clerical force for the organization and management of the citations and references to the world's biomedical literature. Thus it provides an opportunity for very rapid access to references and for retrieval of these materials by subject categories.
Medical Library Needs
NLM carried out an extensive survey of American Medical Libraries with the assistance of the Association of American Medical Colleges and the Medical Library Association. The findings were used to construct NLM Extramural program plans: 1. New library construction 3,500,000 square feet; 2. 87 existing libraries require an additional 2 million volumes; 3. There's a national deficiency of the least 3000 trained medical librarians. 10 schools of library science provide courses in medical librarianship; only about 40 new professionals are being added to the medical library field each year.
Drug Information Clearing House
The Library began intensive planning for its role in a proposed Departmental Drug Information System. The library will establish, as part of the system, a drug literature and clearing house with $1 million in the 1966 budget. The library will: 1. Establish a switching station (provide more information) to facilitate access to the best source of published information on drugs; 2. Increase the depth and specialization of indexing of the drug literature in the MEDLARS system; 3. provide special services to users with drug information including references and full documents, demand searches of MEDLARS, and special bibliographies. The library will establish a unit made up of personnel of specialized technical skills including chemists, pharmacists, pharmacologists, and physicians.
Senator Hill. Doctor, the Congress approved appropriation language last year and encouraged you to develop an extramural program to assist our nation's medical libraries. Why aren't you requesting funds in this budget to activate this program?
Dr. Cummings. Mr. Chairman, there are modest amounts in the budget before us for the extramural portion of this program. However, I must admit that there are no appreciable funds contained in this budget to fully mount an extramural program which would be geared to meet our nation's medical library needs. Such funds were requested- [Interrupts]
Senator Hill. You did request them?
Dr. Cummings. Yes, sir.
Senator Hill. Were they denied by the Department or by the Budget Bureau?
Dr. Cummings. Last year I made the serious mistake of assuming the Department in its budget review had been the principal source of deletion of budget requests. I should answer your question this year by saying that our extramural funds were primarily deleted by the Bureau of the Budget although there were other deletions en route.
Senator Hill. How much in terms of funds were deleted by the Bureau of the Budget?
Dr. Cummings. In the aggregate from the time of our original submission of our preliminary budget, estimates to the complete review of our budget there was more than $5 million deleted from our original submission. I have a budget history before me which I would like to provide to the Committee if you wish or perhaps Mr. Kelly would wish to speak to that.
Senator Hill. We would like to have that in the record.
Medicine History Research and Training
Senator Hill. Why are you cutting back on support for research and training in the field of history of medicine when the Congress directed you to implement this program last year?
Dr. Cummings. This is part of the larger problem related to the loss of extramural program funds. The field of History of Medicine we feel is most important and I believe deserves more support. Perhaps the most embarrassing part of this budgetary item is that we have begun to support activities in this field and the cut will require a major curtailment of the program.
Senator Hill. You mean programs that you are now supporting you will not be able to continue.
Dr. Cummings. We will not.
Senator Hill. How much would you need to continue these programs in terms of funds?
Dr. Cummings. We would need about $2,500,000 to continue the commitments that were made this year and to provide support for a reasonable number of those grants that have been approved and recommended for payment.
Senator Hill. Those grants were approved by you and by your Board, the Library Board?
Dr. Cummings. Those grants are first reviewed by a study section in the same way that NIH grants are reviewed, and then reviewed for program content and appropriateness by the Board of Regents of the National Library. They make the final recommendation to Surgeon General.
Decentralization of MEDLARS programs
Senator Hill. Last year this Committee expressed its interest in strengthening the central MEDLARS program and decentralization of the programs at a number of university medical centers. I know there is a reduction in funds for decentralization of MEDLARS.
Dr. Cummings. The library has strengthened its central MEDLARS program as directed by Congress. We have begun to decentralize this program through the revision of our tapes combined with funds to support machine searching at several university medical schools. However, the plan to make these materials and resources available to six or eight medical centers will not be implemented because of the amount of funds available.
Senator Hill. Because of the reduction by the Bureau of the Budget?
Dr. Cummings. Yes, sir; that reduction took place in the Bureau of the Budget.
Interview with Martin Cummings, MD, Director Emeritus, National Library of Medicine, 1964-84; interviewed by Cheryl Dee, PhD, 2009.
Senator Lister Hill and Dr. Cummings--NLM Budget
Dr. Dee. Dr. Cummings, do you have any overall comments on the 1965 testimony?
Dr. Cummings. The most important part of the 1965 Senate Hearing deals with the exchanges between the Chairman of the Subcommittee, Senator Lister Hill, and me as the Director of the National Library of Medicine. Essentially it reveals that Senator Hill is aware that the budget request of the National Library of Medicine was considerably reduced prior to its arrival at the Congress Subcommittee to the Committee on Appropriations.
The exchange with Senator Hill provides the Director of the National Library of Medicine with a significant opportunity to restate the budgetary needs of the Library programs and makes it clearer that the request was decimated by the Bureau of the Budget. The Bureau of the Budget is an instrument of the Office of the President of the United States. Ordinarily federal executives are not permitted to oppose the budget submitted by the Department in which it resides. Given protection by the Chairman of the Senate Subcommittee, I was able to make an end run around to the President's budget revealing that $5 million was reduced from our request. At the same time I was given the opportunity to restate the needs for the funds to support existing and new extramural programs. Specifically Senator Hill revealed his interest in programs such as the history of medicine research, library research and library training.
The Senate interest in the creation of a special drug information program is reflected in his questions. Senator Hill revealed his determination to fulfill its portion of the commitment made to the Congress in the previous year.
Decentralization of MEDLARS
Dr. Dee. Dr. Cummings, please tell us any background you recall about the decentralization of MEDLARS.
Dr. Cummings. The concept of decentralization of MEDLARS was part of the general planning by Dr. Brad Rogers and his staff. The implementation of this idea took place concurrently when the President's Commission on Heart Disease, Cancer and Stroke began talking about the creation of regional medical programs. We joined in this effort and created regional medical library programs concurrently with those integrating medical library services with regional medical services as a coherent set of activities.
Institutions and Programs
- NLM Board of Regents. https://www.nlm.nih.gov/od/bor/
- NLM Extramural Programs (Grants and Funding). https://www.nlm.nih.gov/ep/
Articles and Oral Histories
- Adams, Scott. "MEDLARS and the Library Community." Bull Med Libr Assoc. 1964 January; 52(1): 171-177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198089/
- Adams, Scott. "MEDLARS: Performance, Problems, Possibilities." Bull Med Libr Assoc. 1965 April; 53(2): 139-151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198250/
- Adams, Scott. "The Way of the Innovator: Notes toward a Prehistory of MEDLARS." Bull Med Libr Assoc. 1972 October; 60(4): 523-533. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC197742/
- Dee, CR. "The development of Medical Literature Analysis and Retrieval System (MEDLARS)." J Med Libr Assoc. 2007 October; 95(4): 416-425. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000779/
- Lipscomb, Carolyn E. "Lister Hill and his influence." J Med Libr Assoc. 2002 January; 90(1): 109-110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64768/
- Phillips, Harlan B. Lister Hill Oral History, interviewed by Harlan B. Phillips, Jan.-June 1967. https://oculus.nlm.nih.gov/2935109r