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 1977
From interviews with Dr. Cheryl Dee, 2010-2011
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 1977
WEDNESDAY, FEBRUARY 4, 1976
U.S. SENATE . . . Subcommittee of the Committee on Appropriations
STATEMENT OF DR. MARTIN M. CUMIMNGS, DIRECTOR, NATIONAL LIBRARY OF MEDICINE
Senator Magnuson. Our next witness will be Dr. Martin Cummings of the National Library of Medicine.
Dr. Cummings' Opening Statement
Perhaps the prime tool of modern technology is the computer, and NLM has pioneered its use for bibliographic information storage and retrieval. A computerized reference retrieval system was installed in 1964 to help cope with increasing amounts of biomedical literature. This system, known as MEDLARS I, permitted both computerized production of Index Medicus and automated searches of the entire bibliographic data base by health professionals. Last year a more sophisticated bibliographic processing system, MEDLARS II, was implemented successfully which has enabled NLM to develop new services and extend its existing services to a larger segment of the health community.
MEDLINE (MEDLARS-online) is now available in some 388 institutions at home and abroad. It facilitates rapid communication between the health professionals and the NLM's MEDLARS data-base, which contains references to relevant medical literature. The network will be expanded to provide access to many smaller hospitals and community-based academic institutions with preclinical and paramedical training programs. I am pleased to report that one of the newer capabilities has permitted the inclusion and searching of abstracts.
LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS
The Lister Hill National Center for Biomedical Communications is the primary research and development arm of the NLM. The Center provides technical information, support and consultation to the health agencies and the health community on matters related to the broad application of computer and communication technology. It continues to develop and coordinate experimental communication networks and systems to improve health education, medical research, and the delivery of health services. In the past we have reported to this committee the successes we have had with increasing the effectiveness of health care delivery and health education in remote areas of the Nation. We have developed and supported experimental interactive television networks in the New England area and have fostered demonstration projects which apply satellite communications technology in the native villages of Alaska. New England's network is now completely supported through user fees, private contributions, and other sources of funding. This is a measure of its success.
The Alaska experiment demonstrated it was possible to extend the services of a hospital-based physician to distant villages by the use of telemedicine conferences. The closely linked Washington/Alaska/Montana/Idaho (WAMI) program demonstrated the benefits of regional sharing of resources in the medical education process. The communications network permitted faculty and students located on multiple campuses and at remote clinical training locations to partake of an integrated medical education program operated by the University of Washington in Seattle.
Based upon these early successes the LHC program has now begun a national experiment in broadband communication with the NASA launch in January of the joint Canadian American Communications Technology Satellite (CTS). There is a great need to share manpower in health education, in accessing medical consultative services, and in disseminating the results of biomedical research. The health experiments which are planned for the CTS satellite afford the health agencies an opportunity to develop models and design systems for sophisticated teleconferencing, for developing regional education programs, and for improving the transfer of biomedical information. These experiments and demonstrations will permit us to identify those communication and information transfer modes which are best suited for a national health broadband communications network.
An additional Center activity which holds great promise is the development within the National Library of Medicine of a modest learning resource laboratory designed to consolidate computer-based educational resources in a single area. It is desirable to have the power of the computer available to libraries, computer-based education, and medical practice at those locations where providing access to large computers is presently either not feasible or very costly. Within this modest laboratory, we plan to develop and test relatively inexpensive combinations of various minicomputers and terminals which are easy to access and can manipulate data to satisfy individual application needs at costs which the user can afford.
MEDLINE USER CHARGE
Senator Magnuson. A couple of years ago you placed a user's charge on all information from the computer. What impact has this had on people using this national information network?
Dr. Cummings. While it is true that users of the Library's national information network are now paying for services which they received free of charge, prior to August 1973, the implementation of user charges has, in my view, been beneficial for three reasons. First, user charges provided to the Library's management was a mechanism which allowed for a more rational expansion of services. Had demands for our services continued unchecked by any constraints, the continued operation of the system would have been jeopardized. Second, user charges enabled the Library to develop a schedule of charges which enabled all users to have equal access to the network independent of their distance from the Library's computer. Lastly, user charges were established at rates which are sufficiently modest so as not to discourage bonafide use but at a level adequate to discourage trivial use of the network. In the aggregate the number of services provided increased from an annual rate of approximately 165,000 in fiscal year 1973 to an estimated 500.000 in fiscal year 1976. The continued growth of the network, after the introduction of user charges, has proven that the services provided are satisfactory and timely.
LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS BUILDING
Senator Brooke. Dr. Cummings, what kind of progress can I tell Senator Lister Hill we are making on his building?
Dr. Cummings. The Lister Hill Center will soon become a reality now that the Congress has appropriated $26 million for its construction. The architectural and engineering drawings were completed last July and the General Services Administration is prepared to advertise for construction bids as soon as the funds are apportioned and necessary environmental impact statements have been processed. We expect construction to commence in the Fall of 1976. The initiation of this project will not only alleviate the severe space problem within the present Library, but will provide specialized facilities in order to enhance communications systems for health education, research and practice in this Nation.
Interview with Martin Cummings, MD, Director Emeritus, National Library of Medicine, 1964-84; interviewed by Cheryl Dee, PhD, 2010-2011.
Dr. Dee. Dr. Cummings, the 1976 Testimony provides a concise summary of the current business of the NLM. Senators Magnuson and Brooke from the Subcommittee did not have many questions for you this year.
Dr. Cummings. Yes, this Testimony primarily summarizes the reports from the NLM.
MEDLARS II - MEDLINE
Dr. Dee. Your annual "Opening Statement" to the Subcommittee mentions that the implementation of the more sophisticated bibliographic processing system, MEDLARS II, enabled NLM to develop new services and extend its existing services to a larger segment of the health community.
Dr. Cummings. The extension of services to more health care professionals was the primary justification given by NLM for the MEDLARS II faster and more efficient processing system. MEDLARS II allowed us to serve many more user groups. MEDLINE, which is MEDLARS-online, was growing rapidly. MEDLINE allowed a rapid communication between the health professional and our MEDLARS database. NLM was pleased to now be able to expand the network and provide much needed access to many smaller hospitals and other academic and preclinical programs.
MEDLINE User Charges
Dr. Dee. In the testimony, you mentioned that the implementation of user charges had some beneficial outcomes.
Dr. Cummings. The user charges continued to be evaluated. The Testimony reports the changes in the user fees.
Lister Hill National Center for Biomedical Communications
Dr. Dee. The testimony reports that the Lister Hill Center building construction was funded.
Dr. Cummings. Yes, $26 million.
Dr. Dee. The Lister Hill National Center for Biomedical Communications is one of the primary topics. The testimony provides a concise summary of the primary accomplishments during this time.
Dr. Cummings. At this particular time, the Lister Hill Center had been working on computer and communication technology in order to address the problem of increasing healthcare delivery and health education in remote areas of our nation. We were developing interactive television networks in the New England area and demonstration projects that used satellite communications in small villages of Alaska. The success of this project can be seen in the fact that the New England network began to be completely supported by its own user fees and private funding contributions.
The Lister Hill Center was beginning a national experiment in broadband communications with the NASA launch of the CTS satellite. These experiments were designed to help NLM further identify communication and information transfer modes best suited for what we hoped would be a national health broadband communications network. These experiments would provide the health community with systems and models for teleconferencing throughout the country and for improving the transfer of health care information across the United States and in particular in the rural areas that were underserved.
The Lister Hill Center was also setting up laboratories to work with the use of microcomputers to make information available to a larger number of users for computer-assisted instruction programs for healthcare professionals around the country.
Dr. Dee. Dr. Cummings, did you have any international negotiations to obtain the joint use of the Canadian American Communications Technology Satellite (CTS) LHC program's that began with the NASA launch of the joint Canadian American Communications Technology Satellite (CTS)?
Dr. Cummings. No, Dr. Ruth Davis planned and worked with all of the other institutions to negotiate inter-institutional agreements. I did not work with Canadian politicians regarding the satellite. This use of the broadband communication was a significant technological advance and Dr. Davis was a very effective leader in this capacity. My international work was in a different area of NLM's operations.
[Update, July 10, 2011.]
Dr. Cummings and the Lister Hill National Center for Biomedical Communications Building News
Dr. Dee. [Phone call from Dr. Dee to Dr. Cummings, July 10, 2011 ] Hi. This is Chery. How are you today? I have a quick question; I was just re-reading a paragraph in the 1976 testimony when Congress finally appropriated the $26 million for the construction for the Lister Hill Center building. When you heard the news were you excited, relieved, or what was your reaction?
Dr. Cummings. It is an easy answer to your question. I changed my mind from retiring from NLM and decided to stay at NLM.
Dr. Dee. How long had NLM been trying to get the funding?
Dr. Cummings. It seemed like forever. What was the date of this Testimony? 1977? I think we had been trying to get funding for about 5 years, probably since 1971.
Institutions and Programs
- "Hermes Satellite Communications Technology Satellite (CTS)." Online Journal of Space Communication; An International Electronic Journal. https://spacejournal.ohio.edu/issue4/historal_hermes.html.
- "Lister Hill National Center for Biomedical Communications." Chapter 23 in Wyndham D. Miles. A history of the National Library of Medicine: the nation's treasury of medical knowledge. Bethesda, Md. U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine; Washington, D.C,1982. https://www.nlm.nih.gov/hmd/manuscripts/miles/miles_23.pdf.
Articles and Oral Histories
- Dee, CR. "The Development of the 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/.
- Smith, Kent. "Laws, leaders, and legends of the modern National Library of Medicine." J Med Libr Assoc. 2008 April; 96(2): 121-133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268223/.
- Sodergren, Linnea. "MEDLARS II: A Review". Bull Med Libr Assoc. 1973 October; 61(4): 400-407. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198718/.