The increasing amount of medical literature and the rising costs of operating a comprehensive medical library is outstripping the capacity of any one institution to furnish adequate support. The National Library of Medicine recognizes its inability to meet the medical literature needs of the entire Nation without support from a network of regional libraries. It is both economical and logical to prevent the deterioration of these reservoir libraries by furnishing Federal support in recognition of the vital function which they are already performing. Failure to secure greater support will result in less effective service which will jeopardize existing support. In many communities there are no other institutions able to meet these needs if existing regional libraries fall victim to rising costs and increasing demands without means of increasing income.

In conclusion, the Medical Library Association, representing about 2,000 medical libraries and librarians throughout the world, wholeheartedly supports the provisions of this bill. The impact which Federal moneys, particularly grants for research and teaching in medicine, have had on U.S. medical libraries is profound. It has made the needs of the users far outstrip the abilities of the institutions with which the libraries are connected to support them. Unless the scientific information handling apparatus of the country is brought up to the level of the research, teaching, and patient care of this country, we may very well see either a decline in the status of our medical sciences, or find different and more expensive methods of reaching the same goals being attempted by society. We urge, therefore, that the House pass H.R. 3142, the Medical Library Assistance Act of 1965, speedily, and we hope that the necessary funds to implement it will be provided in the next Executive budget.

Thank you.

(Dr. Brandon's full statement follows:)

STATEMENT BY ALFRED N. BRANDON, PRESIDENT, MEDICAL LIBRARY ASSOCIATION, AND DIRECTOR, WELCH MEDICAL LIBRARY, JOHNS HOPKINS UNIVERSITY

INTRODUCTION

Mr. Chairman, gentlemen of the committee, my name is Alfred N. Brandon. I am president of the Medical Library Association; chairman of its Federal relations committee; and director of the Welch Medical Library, Johns Hopkins University, Baltimore, Md. The Medical Library Association has designated me to present its views and recommendations on H.R. 3142. It is a privilege to ap pear before this distinguished committee to urge your recommendation of this bill which is of incalculable importance in the revitalizing of medical libraries whose mission it is to preserve, organize, and transfer published knowledge resulting from the research efforts that Congress has, itself, done so much to foster through its long and splendid support of health legislation.

Section 393

Despite other programs of support for the construction of health-related facilities, medical libraries have never received an adequate share of assistance. A recent survey of 116 established medical, dental, osteopathic, and public health schools shows that 86 of their libraries were in need of funds for construction of new facilities and 18 needed funds for renovating existing library quarters.

During the last 8 years I have visited most of the medical school libraries in the United States. With few exceptions, I found them overcrowded with little expansion possibilities in their present stacks. Seating capacities were generally low in relation to the clientele served and work areas for the librarians were at a premium.

The enactment of this bill would do much to improve the physical facilities of medical libraries. The total estimated need for construction for medical, dental, osteopathic, and public health schools, both established and new, at 75 percent

matching, is over $96 million. This kind of support would represent a significant step toward meeting this critical need.

Section 394

The most important element in the success of any venture are the people who operate it. Funds for books, for buildings, for equipment-keypunches, sorters, computers will avail little if we do not have knowledgeable, imaginative, and dedicated people to transmute them into live library service.

The critical shortage of qualified personnel in all areas of science information handling has been emphasized over and over in reports of recent years on communication problems in science, notably in the Surgeon General's Conference on Health Communications (1962), the President's Science Advisory Committee's Science, Government and Information (1963), the National Academy of SciencesNational Research Council's Communication Problems in Biomedical Research (1964) and in the recommendations of the President's Commission on Heart The Medical Library Association has made the Disease, Cancer and Stroke. problem the pivot of its activities, e.g., its programs for continuing education, certification, and recruiting. I think it would be accurate to say that we consider shortage of personnel plus shortage of professional training opportunities our No. 1 problem. This point of view is brought out well in "Guidelines for Medical School Libraries" (1965) prepared by a joint committee of the Association of American Medical Colleges and the Medical Library Association.

The usual minimum professional preparation for librarianship is a bachelor's degree followed by a year of graduate study for the master's degree in one of the Ten of these schools now offer a single country's 33 graduate library schools. course in medical librarianship varying from 30 to 45 semester hours. Three medical libraries offer post-master's training programs with a total of eight places These offerings are tied in with the Medical Library Assoeach year available. ciation's certification plan. They are very useful, but they do not go far in alleviating the overall shortages and there is nothing more except scattered courses in information science which are not directly concerned with the health sciences field.

Information assembled by the President's Commission on Heart Disease, We lose 150 through Cancer and Stroke shows that we are short at least 3,000 professional librarians in the 6,300 health science libraries at the present time.1 normal attrition each year and we bring in from the library schools 100 of whom 60 already hold medical library positions. Thus only an approximate 40 new people, many of whom have neither subject background nor special training of any sort for the health sciences, are added annually. Positions are commonly open for 6 to 8 months, not infrequently for a year or more even in top locations Veteran head librarians are flooded with requests for recomand situations. There is mendations for vacant positions from every part of the land. The well-qualified, sometimes even half qualified, are courted on all sides at all levels. To fully appreciate existing conditions constant reshuffling of people and jobs. one must remember that medical libraries are for the most part very seriously The effects of such conditions on undermanned even when all positions are filled. service are obvious.

Meanwhile the demands on libraries become both larger and more complex as we struggle not only with the size of the literature, but also with its rapidly evolving interdisciplinary nature which requires a whole realining of the traditional concept of scope of collections and public services. Expansion and change in the literature are, of course, the direct result of expansion and change in research personnel, the same personnel who account, in turn, directly or indirectly, A few of the larger for all calls on the library for larger collections and greater services. The cycle continually winds back on itself in wider and wider circles. libraries are beginning to attempt to hold this spiral in place by the automation of library operations and the pioneering of library-based information and search centers, but these experiments only increase the need for staff, highly qualified staff at that. Too, any success in finding new ways of handling information For processing affects the profession as a whole and steps up the urgency of equipping everyone in it to take as much advantage as possible of the innovations. example, the librarian in the field needs some insight into the system to obtain for his clientele full benefits from medlars. The more he knows about both medicine and data processing the better his insight will be.

1 U.S. Congress. House. Committee on Appropriations. Departments of Labor and Health, Education, and Welfare appropriations for 1966. Hearings before a subcommittee of the Committee on Appropriations, House of Representatives, 89th Cong., 1st sess. Department of Health, Education, and Welfare. Pt. 2, Public Health Service (exclusive of National Institutes of Health), Washington, D.C., Government Printing Office, 1965.

Our personnel shortages then are in both number and kind. There is no choice but to find recruits with subject background in the sciences for many of our positions and recruits who are acquainted with at least the elements of data processing and information science for others. There must be people on the staff who can interpret the library to programers, systems designers, computer experts, etc., and work with them to devise new and better patterns and procedures. But can we indeed find these recruits?

From what experience we have had, we know that students with appropriate subject background and academic qualifications can be drawn into librarianship and other areas of information work once they are aware the field exists. Awareness increases as scholarships, fellowships, and traineeships become available, as new programs are offered in the library schools and related institutions and as salary and status improve. Moreover, so far as shortage in kind of personnel is concerned, we are not without a backstop of able practicing librarians eager to learn as much as they can of the new technology, eager to improve their subject competence, and to add to their foreign language proficiency. This has been demonstrated by attendance at the association's continuing education classes, in the organization of workshops and short courses in some parts of the country, and by individual enrollment in university courses.

The truism holds as elsewhere that people go where opportunity beckons. H.R. 3142 provides for most of the opportunities we have long sought: assistance for developing programs in medical library science and in the general field of communication in the health sciences, traineeships and fellowships for students seeking graduate degrees in these areas, internship programs in medical libraries. and retraining for those already working in the health information area. Section 396

Medical libraries are twice as old as medical schools, and during the long years of their existence, their librarians have accumulated a large store of experience which has served them well until the past decade. During the past 10 years, knowledge, including medical knowledge, has become central in our society, and there has been a tremendous increase in the urgency to have medical knowledge immediately available for the treatment of those ill, for the protection of those well, and for the research on which cure and protection rest. In these modern circumstances, the old cut-and-dry, haphazard methods for acquiring new knowledge and techniques in medical library science have failed. It is now necessary to adopt the methodology of the sciences and to formulate and prosecute programs of research and investigation which will yield information that will improve medical library techniques. In particular, funds are needed for research and development in the application of computers to the processing, storing, retrieving, and distributing of medical information. Such investigations have begun in some libraries, but money is sorely needed to train new investigators to support their investigations and to make available to them expensive equipment required for the development of new techniques. Thereby, the passage of H.R. 3142 will contribute to the development of wholly new medical library systems.

Section 397

Section 397, "Grants for Improving and Expanding the Basic Resources of Medical Libraries and Related Instrumentalities," is perhaps the most important part of this bill. Medical library collection needs based on suggested standards indicate a total of $102,732,952 would be needed to bring these libraries up to recommended strength. An analysis of needs would substantiate the propriety of suggesting a considerable larger annual appropriation for resources than the $3 million the bill presently contains. Administered wisely, this provision can in some way reach every aspect of the medical community: student, researcher, and practitioner of all health professions. It is important to recognize the magnitude of this need and to understand that the appropriation authorized by this section woudl hardly begin to provide the solution.

Current statistics show that Federal support of medical and health-related research has grown from $105 million in 1951 to an estimated $1.3 billion in 1965. National Institutes of Health research grants supported 1,695 projects in 1951. By 1964, NIH granted funds for 15,242 projects. Of the total national and private expenditures for health-related research in 1964, the Federal Government provided 65 percent, industry 23 percent, and other non-Federal sources 12 percent of the funds.

The Federal Government provides two-thirds of the support for medical research and should rightly be concerned with seeing to it that the scientists performing this work have available to them needed tools and equipment including adequate libraries.

Section 398

Sections 397 and 398 of the bill recognize that certain larger medical libraries extend their service beyond their immediate constituencies to share resources with nearby hospitals, medical schools, publishers, municipal, State and Federal governmental agencies, as well as other public and private institutions requiring access to medical literature. In many cases, the members of these regional resources facilities are carrying most of the costs even though their own use of the library is a small proportion of its service load.

Government grant support allocation for overhead goes to the institution where the principal investigator has his primary affiliation but does not reach the regional library to which these investigators turn when the libraries of their own institutions prove inadequate.

These sections of H.R. 3142 also recognize that all medical libraries do not need to be self-sufficient (if, indeed, any medical library could achieve completeness today). Smaller collections may satisfy a large percentage of immediate clientele needs and they may be effectively supplemented by a nearby regional library which can fill requests for less demanded but frequently very expensive material.

In different parts of the country, this regional function is performed by different types of libraries; in some cases medical school libraries are serving the entire community, in other cases private hospitals, medical societies, and governmental agencies are performing this reservoir function.

The increasing amount of medical literature and the rising costs of operating a comprehensive medical library is outstripping the capacity of any one institution to furnish adequate support. The National Library of Medicine recognizes its inability to meet the medical literature needs of the entire Nation without support from a network of regional libraries. It is both economical and logical to prevent the deterioration of these reservoir libraries by furnishing Federal support in recognition of the vital fur ction which they are already performing. Failure to secure greater support will result in less effective service which will jeopardize existing support. In many communities there are no other institutions able to meet these needs if existing regional libraries fall victim to rising costs and increasing demands without means of increasing income.

CONCLUSION

Scientific libraries are one way which our society has devised for the purposes of diffusing innovation and of preserving accurately the information which has already been uncovered in the fields of science. As Santayana has noted, those who are ignorant of the past are condemned to repeat it, and where knowledge uncovered at one time or place is unknown to those who need to use it at another time or place, the forward movement of all science is slowed down by the necessity for repetition of experimental work and pragmatic solutions to problems. In a field as vital as medicine, moreover, information or methods uncovered in one part of the globe must be transmitted to all other parts of the globe. Health and disease know no political or geographical boundaries, and illness in rural areas of the United States requires as high a standard of treatment as illness in Bethesda, Md., New York City, or Chicago.

H.R. 3142 contains provisions which will aid science in the transmission of new knowledge and the methods by which it is preserved and brought forth when needed. It provides for research in methods of handling scientific data, so that society can get the most efficient return for the money it invests in medical libraries; and it provides for the training of people who will handle these data. It allows for support of syntheses of existing knowledge so that each individual does not himself have to go through the entire record to extract the meaningful portions for his field, and it provides for the compilation of historical discussions of the means whereby the discoveries were made, thus (hopefully) pointing out more fruitful ways to investigate problems in the future.

Since the results of medical advance are now preserved in written form, the bill makes provision for the collection of such publications in strategic positions around the country, as well as for the buildings and other storage depots which will contain these publications. But it also sees to it that the exciting new frontiers of the transmission of medical data, as exemplifed by the medlars system at the National Library of Medicine, are expanded and made available on a wider scale. The Medical Library Association, representing about 2,000 medical libraries and librarians throughout the world, wholeheartedly supports the provisions of this bill. The impact which Federal moneys, particularly grants for research and

teaching in medicine, have had on U.S. medical libraries is profound. It has made the needs of the users far outstrip the abilities of the institutions with which the libraries are connected to support them. Unless the scientific information handling apparatus of the country is brought up to the level of the research, teaching, and patient care of this country, we may very well see either a decline in the status of our medical sciences, or find different and more expensive methods of reaching the same goals being attempted by society. We urge, therefore, that the House pass H.R. 3142, the Medical Library Assistance Act of 1965, speedily, and we hope that the necessary funds to implement it will be provided in the next Executive budget.

The CHAIRMAN. Thank you very much.

Are there any questions?

Mr. O'BRIEN. I have one, Mr. Chairman.
The CHAIRMAN. Mr. O'Brien.

Mr. O'BRIEN. Doctor, you mentioned the critical shortage of medical librarians. Is the principal reason for that inadequate salaries? Dr. BRANDON. Partially, sir. There are, as I think is brought out in the President's Commission on Heart Disease, Cancer, and Stroke, only 3,000 professional librarians in over 6,000 health science libraries at the present time and we are only recruiting about 40 or 50 a year to try to fill the gap and to create the replenishment that we need for those that we lose by attrition, death, retirement, and so forth.

Mr. O'BRIEN. Are these people being siphoned off into other areas where their knowledge pays more?

Dr. BRANDON. Yes, this has happened and is happening more all the time.

Mr. O'BRIEN. Thank you.

The CHAIRMAN. Are there further questions?

Mr. ROGERS of Florida. Mr. Chairman, I have just one question. The CHAIRMAN. Mr. Rogers.

Mr. ROGERS of Florida. Are you saying in your testimony that you think we need 6,000 librarians?

Dr. BRANDON. No; I am not saying that. I am saying that the President's Commission on Heart Disease, Cancer, and Stroke shows that we were short at least 3,000 professional librarians in the 6,300 health science libraries at the present time.

Mr. ROGERS of Florida. Some of the testimony that we developed shows that in some of the hospitals which they include in the 6,000 figure they may have medical journals or something that people very seldom use. I doubt if a person could spend full time in some of these hospital libraries as a librarian. Would you agree with that? Dr. BRANDON. I think there is a very definite need for what we might call the medical library technician, an individual who may not have a library science degree per se but someone who has had some training and experience in library methods. This individual in a small hospital library could very much better cope with the library problems than a secretary who is usually given a few hours a week to take care of this.

Mr. ROGERS of Florida. I will agree with that. I would hope, too, that we would put more emphasis on our medical libraries in the hospitals, because a number I have seen or know of appear to not be used too frequently.

Dr. LANDON. I think they have on the whole been quite inadequately cared for and I think if we could train some of these medical library technicians that could, for lesser salaries than a professional librarian might command, give attention to this matter. Perhaps