programs. They would not, however, meet the specific need for a mechanism to bring trained physicians into medical library work. We find the fellowship proposal of interest primarily in that it may serve as one means of attacking the growing need for better communication between the biomedical professions and the lay public. Such fellowships could, we believe, be made to provide suitable physicians with the necessary time and professional advice to enable them to turn out authoritative reports primarily designed for lay consumption. It might also make it possible for certain physicians to contribute communications in depth in fields, such as medical history, that tend to narrow the gap between medicine and the humanities.

FUNDS FOR IMPROVING AND EXPANDING BASIC RESOURCES

Next to funds for construction, we regard this provision of the bill to be the most fundamental. It would provide in some instances for much needed expansion of holdings, especially of periodicals. Perhaps more important, it would give small libraries the opportunity of building up microfilm or microcard collections covering items that are unprocurable in the original. Runs of many important biomedical journals, for example, can often be acquired in this form at reasonable cost but are prohibitively expensive (or unprocurable) in the original. Such funds would also make it possible for libraries to expand their copying facilities so that most loans can be issued in copy instead of in the original. This system, now thoroughly tested in several centers, not only spares wear and tear on the original source but provides the reader with a permanent copy for his own use. We also trust that funds under this provision could be used, where indicated, to bring salary scales of library workers to a reasonable level. In many instances, library workers are paid at the bottom of an institution's pay scale and desert the library as soon as a better paid opening is available. We believe the descending scale of awards under this provision ($200,000 or 60 percent of annual operating expenses in the first year; 50 percent in the second; 40 percent in the third, and so on) to be wise and hope that it may serve to induce parent institutions gradually to increase the amounts allocated to their libraries.

RESEARCH AND DEVELOPMENT

The proposal to support research and development in medical library science is especially important in view of rapid progress in storage and retrieval techniques, methods made mandatory by the explosive increase in publication of biomedical material. Also to be considered are improved methods of copying and transmission and other items.

The American Heart Association regards the proposal as a reasonable component of the larger plan to improve the Nation's medical library facilities.

FINANCIAL SUPPORT OF BIOMEDICAL SCIENTIFIC PUBLICATIONS

The American Heart Association strongly approves the proposal of financial support for appropriate biomedical scientific publications of a nonprofit nature. Certain needed scientific journals, particularly of a technical nature with relatively limited, but crucial, readership, not infrequently require financial assistance in the beginning years and in some instances, in subsequent years as well. Likewise, other significant scientific publications may never appear without financial subsidy. A recent example in the caridovascular field is the Journal of Lipid Research (for biochemists and other investigators in atherosclerosis and related research) which was established with wisely expended Federal funds. Likewise, the "Proceedings of the 1964 Second National Conference on Cardiovascular Diseases" and the "Summary of the Conference" are being published through joint support of the National Heart Institute, the heart disease control program, and the American Heart Association.

Since certain highly meritorious periodical publications may not achieve financial stability during the first 3 years, our association recommends that the restriction of grant support to 3 years be liberalized, certainly to 5, and possibly 10 years.

REGIONAL MEDICAL LIBRARIES

The American Heart Association fully supports the provision relating to regional medical libraries but urges that careful consideration be given, in its implementation, to existing medical library developments of a regional nature.

We note, for example, that the Medical Library Extension Service of the University of Wisconsin has been in successful operation since 1926.

Similar services are provided by the University of Nebraska in its State. Most significant, however, is the fact that in both instances the service is not actually promoted or advertised owing to the fact that each is already operating to capacity (but on a very small scale). Similarly, the farsighted efforts of the Medical Library Center of New York should be studied and facilitated in implementing this provision of the bills.

Special consideration should, we believe, be given to the library and information needs of the practicing physician. The Wisconsin and Nebraska operations are primarily devoted to meeting such needs. In some States, including Texas, State medical societies maintain special collections and facilities to serve the needs of practicing physicians which are not, incidentally, always similar to those of the medical student or research worker. We believe that the experience of such units should be carefully studied and that any regional medical library plan should help them to expand and upgrade their operation. The services they render are indispensable and, in most instances, overtaxed. Whether or not such units

join a regional library plan, or cooperate as an independent unit, should, of course, be optional.

In the last analysis, regional organization of medical library facilities is the only solution to the problems created by small collections, inadequate operating funds, and the costliness of modern bibliographic and copying machinery. The American Heart Association believes that the provision relating to regional medical libraries will greatly facilitate existing efforts at regionalization and considers it a wise and useful component of the bills.

In conclusion, the American Heart Association puts itself solidly on record as strongly favoring the Medical Library Assistance proposal (H.R. 3142 and H.R. 6001) virtually in its entirety. Even with careful consideration, we can find no serious fault with it.

More positively, we believe it will make a contribution to the health of the Nation that is out of all proportion to the amount of money requested. Funds for construction and renovation, on a matching basis which should be negotiable within wide limits, are very urgent. So are funds for expansion of collections and services. Training funds are scarcely less important and we urge that some means of making the career of medical librarians attractive to physicians be earnestly sought. The use of funds for research in library and bibliographic techniques seems eminently sensible to us and we hope it will receive favorable consideration. We are especially impressed with the need for Federal funds in support of special types of medical publications. It is paradoxical that there is a sizable number of biomedical publications which, although of little commercial promise, are inordinately valuable scientifically. Finally we support the regionalization of medical library facilities as a logical and highly useful provision. And we again urge that in planning regional organizations previously established units be considered and assisted; and that the library needs of practicing doctors, as well as other categories of physicians, be taken into account.

Finally, the American Heart Association finds that the tangible reasons for supporting the proposal (H.R. 3142 and H. R. 6001) are quite compelling but wishes nevertheless, to place greatest emphasis on the intangible. We believe that progress in biomedical research will be more effectively served by renewed emphasis on sound scholarship than by any other single action now open to us. The medical libraries assistance proposal, if implemented, will be a giant stride in this direction. The CHAIRMAN (Mr. Harris presiding). Thank you very much, Doctor. That concludes your statement?

Dr. WAKERLIN. It does, indeed, sir.

The CHAIRMAN. Should you desire to extend your remarks on the subject in the record, you may have that permission.

Dr. WAKERLIN. Thank you, sir.

The CHAIRMAN. Are there any questions?

We thank you for your appearance and for your presentation on this highly important matter.

Dr. WAKERLIN. Thank you.

The CHAIRMAN. We are glad to welcome the next witness, also, Dr. William A. Sodeman, dean, Jefferson Medical College, Philadelphia, who has with him Dr. Ruhe and Mr. Paul Donelan of the legislative department.

We are pleased to have you gentlemen and we shall be glad to receive your statements.

STATEMENT OF DR. WILLIAM A. SODEMAN, AMA COUNCIL ON MEDICAL EDUCATION; ACCOMPANIED BY DR. C. H. WILLIAM RUHE, ASSISTANT SECRETARY, COUNCIL ON MEDICAL EDUCATION; AND PAUL DONELAN, LEGISLATIVE DEPARTMENT, AMERICAN MEDICAL ASSOCIATION

Dr. SODEMAN. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, I am Dr. William A. Sodeman, a physician residing in Philadelphia, Pa. I am dean of the Jefferson Medical College of Philadelphia and serve as a member of the American Medical Association Council on Medical Education. With me today are Dr. C. H. William Ruhe, assistant secretary of the AMA Council on Medical Education, and Mr. Paul R. M. Donelan, an attorney on the staff of the AMA Legislative Department.

The American Medical Association has always recognized the importance of medical libraries at all levels of education of health personnel. Evidence of this is contained in statements of the "essentials" of various educational programs accredited by the AMA Council on Medical Education. For example, the following paragraph is contained in "Functions and Structure of a Modern Medical School," a statement developed by the American Medical Association and the Association of American Medical Colleges as a general guide in the medical school accreditation program:

A well-maintained and cataloged medical library that can be used conveniently and effectively by both students and faculty is essential to a modern medical school. A trained librarian with experience in medical library work should be employed to supervise the development and operation of the library with the advice and assistance of an active representative committee of faculty. The library should receive regularly the leading medical periodicals, the current numbers of which should be readily accessible. Adequate arrangements should be made by the librarian and the faculty to instruct all students in the use of the library at the beginning of their medical studies.

Similar statements may be found in the "Essentials of Approved Internships," "Essentials of Approved Residencies," "Essentials of an Acceptable School of Medical Technology," "Essentials of an Accredited School of X-Ray Technology," "Essentials of an Acceptable School of Occupational Therapy," "Essentials of an Acceptable School of Cytotechnology," "Essentials of an Acceptable School of Physical Therapy," "Essentials of an Acceptable School for Medical Record Librarians," and "Essentials of an Acceptable School for Inhalation Therapy Technicians."

The medical library is likewise recognized as playing an important role in the continuing education of the practicing physician. The AMA's "Guide Regarding Objectives and Basic Principles of Continuing Medical Education Programs" cites the medical library as one of the important facilities which should be available to the physicianstudent.

The current bills, H.R. 3142 and H.R. 6001, are based on the premises that the massive growth of knowledge in the health sciences in the past 20 years has not been matched by a growth of library

facilities and techniques, and that much of the value of the knowledge and information may be lost unless proper measures are taken to develop the appropriate facilities and techniques. The American Medical Association is in agreement with these premises and believes that action should be taken to provide assistance in the construction of new facilities, the expansion and rehabilitation of existing facilities, the training of professional personnel and the development of new tools and methods for dissemination of medical knowledge and information.

Evidence of the need for assistance is available from information gathered through the annual report of the AMA Council on Medical Education, published in the November 16, 1964, issue of JAMA, and from a series of studies on the subject published in recent issues of the Journal of Medical Education.

A comparison of the 87 existing medical school libraries with minimum standards recommended by a joint USPHS-AMA-AAMC committee (table I) showed that the average existing library was well below recommendations in space, volumes and serial titles during the 1963-64 academic year.

TABLE I.-Comparison of existing libraries with recommended standards

1 From Medical Education Facilities, U.S. Department of Health, Education, and Welfare, Public Health Service, Publication 1180-A-1b, 1964.

Source: Journal of the American Medical Association, vol. 190, No. 7, Nov. 16, 1964, p. 615.

Review of the information provided by the 87 medical schools in existence during 1963-64 revealed startling variations in size and holdings among the various school libraries. The number of volumes. held ranged from 2,000 to 359,000; the number of serial titles from 275 to 5,057. The range in annual budget was from $13,000 to $382,101, and the number of full-time staff varied from a low of 1 to a high of 55. Details are given in table II.

Source: Journal of the American Medical Association, vol. 190, No. 7, Nov. 16, 1964, p. 615.

It is clear from these figures that one should not make general statements about the condition of all medical school libraries. A few appear to be relatively very well off, while many others fall below the minimum standards recommended by the joint committee.

Recent articles in the Journal of Medical Education have shown that expenditures for medical school libraries have not kept pace with the growth in their research expenditures, even though the marked increase in research activity has brought about greatly increased demands upon the library facilities. Similarly, the growth in complexity of activities in medical schools and hospitals has resulted in unusual demand upon the holdings and services of the medical library. Hosts of new professional, scientific, and technical personnel are seeking access to new kinds of scientific and medical information which many medical school libraries are simply not prepared to provide. As a result, there has been some impediment to the flow of productive research and to the availability of research information to professional practitioners.

Detailed information on the current status of private, independent medical libraries, of those in community hospitals, and of those in State and county medical societies and other professional medical societies is not available to us at this time. The AMA is undertaking a study of the status and needs of medical libraries of State and county medical societies; but the results will not be available until later this year.

The American Medical Association strongly supports the intent and purposes of H.R. 3142 and H.R. 6001. We will comment, however, separately on each of the substantive sections of the bill.

SECTION 393. ASSISTANCE FOR THE CONSTRUCTION OF FACILITIES

The American Medical Association supports the concept of the use of Federal funds for the construction of facilities. In implementing these provisions, we recommend that emphasis be given to the requirement that the construction meet demonstrated needs for additional or improved medical library facilities in the community or area. Properly favored, then, would be new medical schools and currently underprivileged institutions.

In addition, we would hope that care would be exercised in the administration of the program, to prevent an overlap in grants with other Federal construction grant programs.

SECTION 394. GRANTS FOR TRAINING IN MEDICAL LIBRARY SCIENCES

We believe that there is a need for professionally trained personnel in medical library science and in related health science fields, as well as in the field of communication of information. The provision of grants for traineeships and fellowships and for the establishment of new training programs, both for new persons entering the field and tɔ modernize and improve the skills and knowledge of persons already in the field, is most important and the American Medical Association supports this section."