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 1974
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 1974
U..S Senate . . . SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS
WARREN G. MAGNUSON, presiding
Cost of acquisitions
The NLM is faced with several significant challenges. First is the increasing cost of literature acquisitions which is having a debilitating impact on all medical libraries. The subscription cost increases have caused many local hospitals and clinic libraries to reduce medical journal subscriptions increasing the demands placed on the NLM and the supporting regional and resource library components of the National Biomedical Communications Network.
Success of MEDLINE
The second challenge the NLM is faced with is the extent of the enthusiastic response of the health community to MEDLINE, our new computerized on-line bibliographic service, has surpassed our own optimistic expectations.
Finally, the NLM is faced with the problems presented by a copyright suit that may result in the prohibition of the NLM and all other libraries from reproducing single copies of journal articles for use by health professionals and students. If libraries are required to pay for licensees and royalties for photocopying, it would tremendously increase the operational costs for the NLM and other libraries throughout the country.
The recently inaugurated MEDLINE, an on-line interactive bibliographic service, has been expanded by adding multi-file capability. Full operation of these files will be achieved in FY 1974 providing the added capability of: (1) locating which libraries in each of the eleven regions holds any of approximately 5,000 medical serials; (2) in addition to searching of current information in MEDLINE (1,200 serials containing approximately 500,000 citations), more extensive searching, of the complete MEDLARS data base; and (3) rapid access to cataloging information on medical monographs and books. The MEDLINE service is now available in 140 health institutions. It is expected that by FY 1974 the number of MEDLINE centers will increase to 200.
The MEDLARS II development project is proceeding satisfactorily and the current schedule calls for system testing at the end of this year.
Lister Hill National Center for Biomedical Communications
This Center has conducted many innovative efforts in health communications research. The potential payoff from this type of development is strikingly illustrated by the success of the MEDLINE system which grew out of a pilot developmental on-line system, AIM-TWX, supported by the Lister Hill Center. This is a good example of the fruits of applied new technology.
The Center is also testing the feasibility and effectiveness of other advanced communication systems. Examples of these are: (1) the Northern New England Interactive TV Network where a number of small community hospitals are linked with a medical school so that medical expertise of the university faculty can be made available to the less-specialized hospitals and (2) computer-assisted instruction projects to modernize health education. These include simulations of clinical situations, more than fifty short courses on a variety of medical topics, ... . Fifty institutions are now using this material.
The Lister Hill satellite communications project demonstrated its effectiveness in remote geographical areas where mountainous terrain or atmospheric conditions make normal communications difficult. Utilizing the NASA ATS-1 satellite, the Center is completing its experiment in Alaska to demonstrate the potential of satellite communications in this environment. It has already been credited by Alaskan physicians with helping save the lives of several seriously ill patients in remote areas of that State.
Medical Library Assistance Act
Probably the most significant of the many accomplishments resulting from this Act is the past and continuing support provided to a national network of medical libraries. Within this network the library sources and services of the small community libraries have been strengthened and the larger medical libraries have been induced to share their collection with these where the majority of the use takes place.
[End of Opening Statement]
Copyright Suit [Williams & Wilkins Co.]
Dr. Cummings. A copyright suit pending against the Government may ultimately prohibit the NLM and all other medical libraries from reproducing single copies of journal articles for use by health science students and professionals. If libraries are required to pay royalties for photocopy, operational costs will increase significantly.
Senator Magnuson. Is that being brought by some of the contributors to the medical magazines? Who brought the suit?
Dr. Cummings. The suit is being brought against the libraries.
Senator Magnuson. I know who it's against, but who brought it?
Dr. Cummings. It was brought by a commercial publishing firm in Baltimore, the Williams & Wilkins Co.
Senator Magnuson. Who reproduces these things themselves?
Dr. Cummings. The Williams & Wilkins Co. receives manuscripts from scientists, and publishes them in formal journals.
Senator Magnuson. Oh, and they don't want you to use it.
Dr. Cummings. The authors do not receive any payment for their contribution. The publishers sell the journals, but they do not want us to disseminate photocopies of articles without paying them a licensed royalty.
Senator Magnuson. That's what I was thinking. For most articles in medical journals, the people that write them don't get paid and don't expect to be paid.
Dr. Cummings. That is correct.
Senator Magnuson. They're making a contribution from their own expertise.
Dr. Cummings. Moreover, I would add, Mr. Chairman that more than half of the articles published in the American medical literature comes from studies supported by the Federal Government. Thus, sponsorship of research which leads to a publication we believe would be in the public domain.
Senator Magnuson. It would be like giving a grant to do certain things, but part of the grant would include making a report to the Federal Government.
Dr. Cummings. That is correct.
LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS
Dr. Cummings. With regard to our Lister Hill National Center for Biomedical Communications, I can report that the Center has made many innovative efforts in health communications research. The potential payoff from such research is strikingly illustrated by the success of MEDLINE which grew out of a Lister Hill Center pilot project. The Center is supporting other projects that we believe have similar potential for significantly improving communications practices in biomedicine. One example is the Alaskan satellite communications experiment, which has demonstrated its effectiveness in geographically remote areas where rugged terrain or atmospheric conditions make ordinary communications difficult. This project, which utilizes the NASA ATS-1 satellite, already has been credited by Alaskan physicians with helping to save the lives of several critically ill patients in remote areas of their State.
Senator Magnuson. Now, under the amount you have suggested here, or supposing we agreed with the House figure, can you continue this Alaskan line, or is there some problem about that?
Dr. Cummings. Well, we have projected the introduction of a more sophisticated health communications system using a new NASA satellite, and with the funds in this budget, we will not be able to implement the program on the scale originally planned. Instead of having coverage in some 25 districts of the Northwest and Alaska, we will restrict the experiment to about 5 or 6 communities. This will scale down the effort to fit the budget.
Senator Magnuson. Well, why was it scaled down? Did you recommend that it be scaled down through the budget?
Dr. Cummings. I think the history of the budget has been--
Senator Magnuson. Do not give me the history. Did you recommend that it be scaled down?
Dr. Cummings. No, I did not recommend that it be scaled down.
Senator Magnuson. All right. And if you had the money to keep it going you could use it advantageously.
Dr. Cummings. If we had the funds, we would implement the plan originally--
Senator Magnuson. If you have not got the funds, why did you mention it here? Why did you not say it is cut out? You mention it is one of the fine things that are being done, but you have not any money to do it.
[See Full-Text Testimony for further discussion.]
Dr. Cummings. Lister Hill Center also supports computer aided instruction experiments in medical education and has demonstrated the successful use of two-way television for teaching and patient care in New Hampshire and Vermont.
Senator Magnuson. All right.
Have you got the money to keep that going?
Dr. Cummings. Yes, that program is entering--
Senator Magnuson. You had better have it or you are going to hear from somebody here on this committee.
Dr. Cummings. I am aware of that, particularly since I know that Senator Cotton participated in a demonstration of the two-way television activity several months ago. Our plan for that experiment, Mr. Chairman, is to provide a terminal year's support as a demonstration and then hope that it will be picked up as an ongoing service operation by the users.
Interview with Martin Cummings, MD, Director Emeritus, National Library of Medicine, 1964-84; interviewed by Cheryl Dee, PhD, 2010-11.
Dr. Dee. Dr. Cummings, it appears that the recently inaugurated MEDLINE was a terrific success by the time of this testimony in 1974.
Dr. Cummings. The success was expected but the extent of the success was beyond our expectations. MEDLINE became quite an achievement with its roots as far back my first NLM deputy, Scott Adams' early work with MEDLARS. Scott Adams was the intellectual leader of MEDLARS. He was the big picture man. He was brilliant. I trusted everything he said and it always turned out to be true. Scott Adams was one of the greatest things I inherited from Brad Rogers when I came to the National Library of Medicine.
Seymour Taine was the technical leader of early MEDLARS and I also credit Davis McCarn, Lister Hill Center Deputy Director from 1967 to 1978, who designed the first experimental online prototype system AIM-TWX.
We must remember the importance of MeSH on the pathway to MEDLINE. In the mid-60s it became clear that the vocabulary of the National Library of Medicine was not adequate for the needs of MEDLARS and the NLM cataloging. I'm not taking any credit for improving the vocabulary, all I did was hire good personnel and bring together teams to improve the vocabulary.
We developed a MeSH advisory committee that was headed by Dr. Peter Olch, a distinguished young surgeon who trained at the University of Washington and who previously worked at the National Institutes of Health. Several scientific organizations and professional societies such as the American Public Health Association and the American Dental Association provided expertise to help us upgrade and broaden the vocabulary particularly in the medical specialty areas. I brought in Norman Shumway from Cleveland Western Reserve and Dr. Joseph Leiter from the National Cancer Institute. I also want to give credit to Winifred Sewell's work with Senator Hubert Humphrey on the vocabulary of the Drug Literature Program. The improvement of the vocabulary was tremendous. The vocabulary profited immensely from the contributions from the scholars and physicians from the scientific and medical communities.
Lister Hill Center
Dr. Dee. Dr. Cummings, the Lister Hill Center continued to conduct innovative research.
Dr. Cummings. The success of MEDLINE grew out of AIM-TWX, a project that was developed by Dr. Ruth Davis and Davis McCarn of the Lister Hill Center. This testimony you sent also points out some specifics of Dr. Davis' satellite program, the Alaskan project and the Northern New England Interactive TV Network. All of these projects were extremely innovative and served to initiate additional research. You can observe Senator Magnuson's interest in the projects.
Copyright Suit-Williams and Wilkins
Dr. Dee. Dr. Cummings, the copyright suit appears to be a serious challenge and a time-consuming struggle for the National Library of Medicine.
Dr. Cummings. The copyright suit against the Government attempted to prohibit NLM and all medical libraries from reproducing single copies of journal articles for use by health science students and health professionals. This suit consumed a significant portion of NLM's time and effort. The Testimony discussion with Senator Magnuson gives important details of the suit. The Testimony tells the story.
Health information must be regarded as a public resource and a public good. In the field of health and medicine it is essential to have free access to information so that medical research can build on the research that came before it. Health care delivery cannot progress without access to the previous experience from earlier clinical studies and other important medical research.
The story behind the copyright suit is that an American publishing company, Williams and Wilkins, demanded the National Library of Medicine to pay for the privilege of photocopying from our journals. We determined that the fair use provisions of the Copyright Act permitted us and all libraries to make single copies for research and educational purposes and we refused to make Williams and Wilkins' payments. Our decision led to litigation against us by the publishers Williams and Wilkins. Williams and Wilkins challenged us in the right courts at the right time and they won the first level review. We were determined to pursue our position and we were able to reverse the judgment at the second level review and then the lawyers for the publishers decided to take the case to the Supreme Court. The Supreme Court, in a close decision, supported us and allowed us to continue our practice of providing single photocopies.
The entire library community gathered behind us in this case, and it strengthened the library community.
- Scott Adams: Rogers, FB. "Scott Adams (1909-1982)." Bull Med Libr Assoc. 1983 April; 71(2): 245-248. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC227157/.
- Joseph Leiter: Kotzin, Sheldon, "Joseph Leiter, FMLA, 1915-2005." J Med Libr Assoc. 2005 October; 93(4): 512-513. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1250335/.
Institutions and Programs
- Joseph Leiter NLM/MLA Lectureship. https://www.mlanet.org/awards/honors/leiter.html.
- NASA ATS-1 satellite. NASA National Space Science Data Center. https://nssdc.gsfc.nasa.gov/nmc/spacecraftDisplay.do?id=1966-110A
Articles and Oral Histories
- Cummings, MM. "A brief recent history of the National Library of Medicine." In National Library of Medicine. Past, present, and future of biomedical information. Bethesda, MD: United States Department of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, 1986; 27-40.
- Cummings, MM. "Copyright and Reproduction." Bull Med Libr Assoc. 1973 Jul; 61(3): 344-345. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198693/.
- Davis, Ruth M. PhD. "The National Biomedical Communications Network as a Developing Structure." Bull Med Libr Assoc. 1971 January; 59(1): 1-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC197535/.
- Fenichel, Carol. "Scott Adams." Oral History Project: Voices of the Past. Medical Library Association, March 20, 1980.115 leaves. https://www.mlanet.org/about/history/adams_s.html.
- Fenichel, Carol. "Winifred Sewell." Oral History Project: Voices of the Past. Medical Library Association, May 11, 1984. 101 leaves. https://www.mlanet.org/about/history/sewell_w.html.
- Fenichel, Carol. "Seymour Taine." Oral History Project: Voices of the Past. Medical Library Association, October 4, 1982, 80 leaves. https://www.mlanet.org/about/history/taine_s.html.
- 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/.